|Trade names||Mobic, Metacam, others|
|Metabolism||Liver (CYP2C9 and 3A4-mediated)|
|Elimination half-life||20 hours|
|Excretion||Urine and faeces equally|
|CompTox Dashboard (EPA)|
|Chemical and physical data|
|Molar mass||351.403 g/mol g·mol−1|
|3D model (JSmol)|
|(what is this?)|
Meloxicam, sold under the brand name Mobic among others, is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain and inflammation in rheumatic diseases and osteoarthritis. It is taken by mouth. It is recommended that it be used for as short a period as possible and at a low dose.
Common side effects include abdominal pain, dizziness, swelling, headache, and a rash. Serious side effects may include heart disease, stroke, kidney problems, and stomach ulcers. Use is not recommended in the third trimester of pregnancy. It blocks cyclooxygenase-2 (COX-2) more than it blocks cyclooxygenase-1 (COX-1). It is in the oxicam family of chemicals and is closely related to piroxicam.
Meloxicam was patented in 1977 and approved for medical use in the United States in 2000. It was developed by Boehringer Ingelheim, however is also available as a generic medication. In the United States the wholesale cost per dose is less than US$0.02 as of 2018. In the United Kingdom it costs about 0.13 pounds as of 2018. In 2016 it was the 36th most prescribed medication in the United States with more than 21 million prescriptions.
Meloxicam use can result in gastrointestinal toxicity and bleeding, headaches, rash, and very dark or black stool (a sign of intestinal bleeding). Like other NSAIDs, its use is associated with an increased risk of cardiovascular events such as heart attack and stroke. It has fewer gastrointestinal side effects than diclofenac, piroxicam, naproxen, and perhaps all other NSAIDs which are not COX-2 selective. Although meloxicam inhibits formation of thromboxane A, it does not appear to do so at levels that would interfere with platelet function.
A pooled analysis of randomized, controlled studies of meloxicam therapy of up to 60 days duration found that meloxicam was associated with a statistically significantly lower number of thromboembolic complications than the NSAID diclofenac (0.2% versus 0.8% respectively) but a similar incidence of thromboembolic events to naproxen and piroxicam.
Cardiovascular side effects
Persons with hypertension, high cholesterol, or diabetes are at risk for cardiovascular side effects. Persons with family history of heart disease, heart attack, or stroke must tell their treating physician as the potential for serious cardiovascular side effects is significant.
Mechanism of action
Meloxicam blocks cyclooxygenase (COX), the enzyme responsible for converting arachidonic acid into prostaglandin H2—the first step in the synthesis of prostaglandins, which are mediators of inflammation. Meloxicam has been shown, especially at its low therapeutic doses, selectively to inhibit COX-2 over COX-1.
Meloxicam concentrations in synovial fluid range from 40% to 50% of those in plasma. The free fraction in synovial fluid is 2.5 times higher than in plasma, due to the lower albumin content in synovial fluid as compared to plasma. The significance of this penetration is unknown, but it may account for the fact that it performs exceptionally well in treatment of arthritis in animal models.
Side effects in animals are similar to those found in humans; the principal side effect is gastrointestinal irritation (vomiting, diarrhea, and ulceration). Rarer but important side effects include liver and kidney toxicity.
In healthy dogs given meloxicam, no perioperative adverse effects on the cardiovascular system have been reported at recommended dosages. Perioperative administration of meloxicam to cats did not affect postoperative respiratory rate nor heart rate.
A peer-reviewed journal article cites NSAIDs, including meloxicam, as causing gastrointestinal upset and, at high doses, acute renal failure and CNS signs such as seizures and comas in cats. It adds that cats have a low tolerance for NSAIDs.
In dogs, the absorption of meloxicam from the stomach is not affected by the presence of food, with the peak concentration (Cmax) of meloxicam occurring in the blood 7–8 hours after administration. The half-life of meloxicam is approximately 24 hours in dogs.
Since 2003, meloxicam has been approved in the U.S. for use in dogs for the management of pain and inflammation associated with osteoarthritis, as an oral (liquid) formulation of meloxicam. In January 2005, the product insert added a warning in bold-face type: "Do not use in cats." An injectable formulation for use in dogs was approved by the FDA in November 2003.
In October 2004, a formulation for use in cats was approved for use prior to surgery only. This is an injectable meloxicam, indicated for as a single, one-time dose only, with specific and repeated warnings not to administer a second dose.
In Europe, where the product has been available since the early 1990s, it is licensed for other anti-inflammatory benefits including relief from both acute and chronic pain in dogs. In June 2007, an oral version of meloxicam was licensed for the long-term relief of pain in cats. Meloxicam is also licensed for use in horses, to relieve the pain associated with musculoskeletal disorders.
As of June 2008, meloxicam is registered for long-term use in cats in Australia, New Zealand, and Canada.
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- Off-label use discussed in: Arnold Plotnick MS, DVM, ACVIM, ABVP, Pain Management using Metacam Archived 2011-07-14 at the Wayback Machine, and Stein, Robert, Perioperative Pain Management Part IV, Looking Beyond Butorphanol, Sep 2006, Veterinary Anesthesia & Analgesia Support Group.
- For off-label use example in rabbits, see Krempels, Dana, Hind Limb Paresis and Paralysis in Rabbits, University of Miami Biology Department.
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- Metacam Client Information Sheet, product description: "Non-steroidal anti-inflammatory drug for oral use in dogs only", and in the "What Is Metacam" section in bold-face type: "Do not use in cats.", January 2005.
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- US FDA Notice of Violation for off-label use promotion, April 2005.
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