Meloxicam

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Meloxicam on Prescriptsy

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Meloxicam is a prescription-only non-steroidal anti-inflammatory drug (NSAID) used to treat pain, inflammation, and stiffness associated with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

It belongs to the oxicam class of NSAIDs and is classified as a preferential cyclooxygenase-2 (COX-2) inhibitor, meaning it provides effective anti-inflammatory and analgesic action with a somewhat reduced risk of gastrointestinal adverse effects compared with traditional non-selective NSAIDs such as ibuprofen, naproxen, and diclofenac.

Meloxicam is available as tablets in two strengths (7.5 mg and 15 mg) and is taken once daily, making it a convenient option for chronic inflammatory conditions.

Musculoskeletal conditions are a leading cause of disability in the United Kingdom.

Osteoarthritis alone affects over 8.75 million people in the UK, according to Versus Arthritis, with the knees, hips, hands, and spine being the most commonly affected joints.

Rheumatoid arthritis, an autoimmune inflammatory condition, affects approximately 400,000 people. Ankylosing spondylitis, an inflammatory condition primarily affecting the spine and sacroiliac joints, affects an estimated 200,000.

NSAIDs are a cornerstone of symptomatic management in all three conditions, providing relief from pain, stiffness, and swelling.

This page provides a comprehensive clinical overview of meloxicam, covering how it works, dosage guidance, potential side effects, important safety warnings, and how to obtain a prescription in the United Kingdom.

Important safety information about meloxicam

Before reading further, note these essential safety points about meloxicam.

• Meloxicam is a prescription-only medicine. Use the lowest effective dose for the shortest duration necessary.
• All NSAIDs carry risks of gastrointestinal bleeding, cardiovascular events, and kidney injury.
• Tell your prescriber if you have a history of stomach ulcers, heart disease, high blood pressure, kidney problems, or asthma.
• Do not take meloxicam with other NSAIDs (including ibuprofen) unless specifically advised by your prescriber.
• Meloxicam is not suitable during the third trimester of pregnancy.

Understanding inflammation and arthritis

Inflammation is the body's natural response to injury or infection, characterised by redness, swelling, warmth, pain, and loss of function.

In conditions such as osteoarthritis and rheumatoid arthritis, inflammation becomes chronic and contributes to progressive joint damage.

In osteoarthritis, the primary process is degeneration of articular cartilage, but secondary inflammation of the synovial membrane (synovitis) occurs frequently and is a significant contributor to pain and stiffness.

In rheumatoid arthritis, the immune system attacks the synovium, producing sustained inflammation that, if untreated, leads to erosion of bone and cartilage and deformity.

In ankylosing spondylitis, chronic inflammation at the entheses (points where tendons and ligaments attach to bone) can lead to new bone formation and, eventually, spinal fusion.

The management of these conditions involves a combination of pharmacological and non-pharmacological approaches.

NICE guidelines recommend exercise, weight management, physiotherapy, and patient education as first-line treatments for osteoarthritis (NG226).

Pharmacological options include paracetamol (though evidence for its efficacy in osteoarthritis is limited), topical NSAIDs (recommended by NICE as first-line pharmacological treatment for knee and hand osteoarthritis), oral NSAIDs (at the lowest effective dose for the shortest period), and, in some cases, intra-articular corticosteroid injections.

For rheumatoid arthritis, disease-modifying anti-rheumatic drugs (DMARDs) such as methotrexate are the cornerstone of treatment, with NSAIDs used adjunctively for symptom relief.

How meloxicam works: mechanism of action

All NSAIDs work by inhibiting cyclooxygenase (COX) enzymes, which catalyse the conversion of arachidonic acid to prostaglandins. There are two main isoforms: COX-1 and COX-2.

COX-1 is constitutively expressed in most tissues and produces prostaglandins that protect the gastric mucosa, support platelet aggregation, and maintain renal blood flow.

COX-2 is inducible and is upregulated at sites of inflammation, producing prostaglandins that mediate pain, fever, and inflammatory swelling.

Traditional non-selective NSAIDs (ibuprofen, naproxen, diclofenac) inhibit both COX-1 and COX-2, which is why they carry a significant risk of gastric mucosal injury and gastrointestinal bleeding.

Selective COX-2 inhibitors (celecoxib, etoricoxib) were developed to spare COX-1 and reduce gastrointestinal toxicity.

Meloxicam occupies an intermediate position: it is described as a preferential COX-2 inhibitor because, at therapeutic doses, it inhibits COX-2 more than COX-1 but does not completely spare COX-1.

This preferential selectivity translates into a lower, though not eliminated, rate of gastrointestinal adverse effects compared with non-selective NSAIDs.

By reducing COX-2-derived prostaglandin production at sites of inflammation, meloxicam decreases inflammatory swelling, reduces pain by lowering the sensitisation of peripheral nociceptors, and alleviates stiffness.

The long elimination half-life of approximately 20 hours means that steady-state plasma concentrations are achieved with once-daily dosing, providing consistent 24-hour symptom control.

Clinical evidence and UK prescribing guidance

Meloxicam has been extensively studied in randomised controlled trials involving patients with osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

The MELISSA (Meloxicam Large-Scale International Study Safety Assessment) trial, a large randomised study comparing meloxicam 7.5 mg with diclofenac 100 mg in over 9,000 patients with osteoarthritis, found similar efficacy for pain relief but significantly fewer gastrointestinal adverse events (including fewer withdrawals due to GI side effects and fewer perforations, ulcers, and bleeds) with meloxicam.

The SELECT (Safety and Efficacy Large-scale Evaluation of COX-inhibiting Therapies) study compared meloxicam 7.5 mg with piroxicam 20 mg and found comparable efficacy with a better gastrointestinal safety profile for meloxicam.

NICE NG226 (Osteoarthritis: care and management) recommends topical NSAIDs as first-line pharmacological treatment for knee and hand osteoarthritis.

When oral NSAIDs are considered, NICE advises prescribing at the lowest effective dose for the shortest duration, co-prescribing a PPI in at-risk patients, and regularly reviewing the need for continued treatment.

The BNF lists meloxicam alongside other NSAIDs and notes its preferential COX-2 selectivity and once-daily dosing convenience.

For rheumatoid arthritis, NICE NG100 recommends early initiation of DMARD therapy (methotrexate is first-line) and emphasises that NSAIDs should be used adjunctively for short-term symptom control rather than as primary treatment.

For ankylosing spondylitis, NICE NG65 recommends NSAIDs as first-line pharmacological treatment, with the choice of NSAID guided by individual response, risk factors, and tolerability.

Meloxicam compared with other NSAIDs

Understanding how meloxicam compares with other NSAIDs helps contextualise its place in treatment.

Ibuprofen is the most commonly used NSAID in the UK, available over the counter at low doses (200 to 400 mg).

It has a shorter half-life (2 to 4 hours), requiring dosing three to four times daily, and is a non-selective COX inhibitor.

Naproxen has a longer half-life (12 to 15 hours) and is taken twice daily.

It is also non-selective but has the most favourable cardiovascular safety profile among commonly used NSAIDs, according to the MHRA.

Diclofenac was one of the most widely prescribed NSAIDs but has been moved to prescription-only status in many formulations due to cardiovascular safety concerns; the MHRA has advised that diclofenac is contraindicated in patients with established cardiovascular disease.

Celecoxib and etoricoxib are selective COX-2 inhibitors (coxibs) with the lowest rates of gastrointestinal adverse events among oral NSAIDs.

However, they carry similar or slightly higher cardiovascular risk compared with naproxen.

Meloxicam sits between non-selective NSAIDs and selective COX-2 inhibitors in terms of both gastrointestinal safety and COX-2 selectivity.

Its once-daily dosing and moderate GI risk profile make it a practical choice when an oral NSAID with better gastric tolerability than ibuprofen or naproxen is desired, but a coxib is not required or preferred.

Dosage and administration

Take meloxicam once daily, with or after food, with a glass of water.

For osteoarthritis, the usual starting dose is 7.5 mg, which can be increased to 15 mg if needed.

For rheumatoid arthritis and ankylosing spondylitis, the usual dose is 15 mg, which may be reduced to 7.5 mg once symptoms are controlled.

Elderly patients should start at 7.5 mg daily and generally should not exceed this dose. The maximum dose for all indications is 15 mg daily.

Do not exceed this dose, as higher amounts increase the risk of side effects without proportional additional benefit.

If you are switching from another NSAID, your prescriber may advise a washout period or may switch directly depending on the half-life of the previous NSAID.

Do not take two different oral NSAIDs at the same time unless specifically instructed by your prescriber.

Side effects of meloxicam

Gastrointestinal effects

Dyspepsia, nausea, abdominal pain, diarrhoea, and constipation are the most common side effects.

Although less frequent with meloxicam than with non-selective NSAIDs, gastrointestinal ulceration, bleeding, and perforation can occur, particularly in elderly patients and those with risk factors.

Warning signs include dark or bloody stools, vomiting blood or material that looks like coffee grounds, and severe abdominal pain. These symptoms require urgent medical attention.

Cardiovascular effects

All NSAIDs are associated with a dose-dependent increase in the risk of myocardial infarction and stroke, particularly with long-term use.

The risk is lowest with naproxen and increases with other NSAIDs, including meloxicam.

Patients with established cardiovascular disease, uncontrolled hypertension, or multiple risk factors should use meloxicam only if no suitable alternative exists and the benefit clearly outweighs the risk.

NSAIDs can cause fluid retention and elevate blood pressure.

Renal effects

Prostaglandins play a role in maintaining renal blood flow, particularly during periods of reduced renal perfusion (dehydration, heart failure, renal impairment).

NSAID use can impair renal function, cause fluid retention, and, rarely, lead to acute kidney injury.

The risk is greatest in elderly patients, those with pre-existing renal impairment, and those taking concurrent ACE inhibitors or ARBs and diuretics.

Other side effects

Headache, dizziness, oedema, elevated liver enzymes, skin rash, and photosensitivity are reported. Rare but serious effects include Stevens-Johnson syndrome, toxic epidermal necrolysis, blood dyscrasias, hepatitis, and severe hypersensitivity reactions. Bronchospasm may occur in aspirin-sensitive asthma.

When to seek urgent medical advice

Stop taking meloxicam and call 999 or attend A&E if you develop signs of gastrointestinal bleeding (black tarry stools, vomiting blood), signs of a heart attack (chest pain, pain radiating to the arm or jaw, breathlessness), signs of a stroke (facial drooping, arm weakness, speech difficulty), severe allergic reaction (swelling of face, lips, or throat, difficulty breathing), or severe skin reaction (blistering, widespread rash with fever).

Contact your GP or call NHS 111 if you experience persistent stomach pain, ankle swelling, unexplained breathlessness, or any symptoms that concern you.

Report suspected adverse reactions to the MHRA at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Meloxicam is contraindicated in patients with hypersensitivity to meloxicam, aspirin, or other NSAIDs, active peptic ulceration or GI bleeding, severe hepatic or renal impairment, severe heart failure, and during the third trimester of pregnancy.

Aspirin-sensitive asthma (a triad of asthma, nasal polyps, and bronchospasm triggered by aspirin or NSAIDs) is a specific contraindication.

Gastroprotection

The MHRA and NICE recommend co-prescribing a PPI for patients at increased GI risk, including those aged 65 or over, those with a history of peptic ulcer disease, and those taking concurrent anticoagulants, corticosteroids, or SSRIs.

Drug interactions

Meloxicam may reduce the effectiveness of antihypertensive medicines. It increases bleeding risk when combined with anticoagulants and antiplatelet agents. Concurrent use with methotrexate may increase methotrexate toxicity.

Lithium levels may rise. The combination of an NSAID with an ACE inhibitor or ARB and a diuretic increases the risk of acute kidney injury.

Avoid concurrent use of two or more oral NSAIDs.

Pregnancy and breastfeeding

NSAIDs are contraindicated in the third trimester and should be avoided throughout pregnancy if possible. Meloxicam is present in breast milk in small amounts; discuss the risks and benefits with your prescriber.

How to get meloxicam in the UK

Meloxicam is a prescription-only medicine available through the NHS. Your GP can prescribe it following a clinical assessment.

Authorised online prescribers registered with the GPhC can also issue prescriptions after an appropriate consultation.

The standard NHS prescription charge in England is 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland. Generic meloxicam is widely available and inexpensive.

Non-pharmacological management of arthritis

Medicines such as meloxicam are most effective when combined with non-pharmacological measures.

NICE recommends regular exercise tailored to your ability (strengthening exercises, aerobic activity, flexibility work), weight management (losing even a small amount of weight can significantly reduce joint loading and pain), physiotherapy, occupational therapy (for advice on joint protection and assistive devices), heat or cold packs for local symptom relief, and psychological support if chronic pain is affecting your mental health.

The NHS offers self-management courses and resources through Versus Arthritis and local musculoskeletal services.

These approaches, combined with appropriate pharmacotherapy, offer the best outcomes for long-term joint health and quality of life.

Sources

• Meloxicam 15 mg Tablets, Summary of Product Characteristics (EMC)
• Meloxicam, British National Formulary (BNF)
• NICE NG226: Osteoarthritis: care and management
• NSAIDs, NHS
• MHRA Yellow Card Scheme