Meloxicam is a member of the oxicam class of nonsteroidal anti-inflammatory drugs (NSAIDs). It is used to treat the signs and symptoms of arthritis, such as joint pain, swelling, and stiffness. Examples of oxicam pain medications include piroxicam, tenoxicam, isoxicam, and droxicam.
The U.S. FDA approved meloxicam in 2000. Its use skyrocketed between 2006 and 2016. In 2006, meloxicam was the 91st most frequently prescribed drug with 8,766,370 prescriptions. The number of prescriptions increased to 21,290,692 in 2016, making it the 36th most frequently prescribed drug in America.
Most notably, meloxicam is the third most frequently prescribed NSAIDs among US Army active-duty soldiers. In 2006, there were 48,928 prescriptions among active-duty soldiers in the US army. The number increased to 101,929 in 2011; however, it decreased to 91,048 in 2014.
While the drug is safe when used as prescribed, misuse or abuse can cause potentially fatal side effects. Many people are also concerned if the drug can cause addiction. Because meloxicam treats pain, many people believe it may act as a gateway drug to opioids (narcotics). Addiction could require treatment in a rehab facility.
What is Meloxicam and How Does It Work?
Meloxicam is an oxicam oxicam class of nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are widely prescribed medications for pain and swelling. Each year, doctors write over 70 million NSAID prescriptions. The number of US adults who used NSAIDs (except aspirin) regularly increased by 41% from 20.57 million in 2005 to 29 million in 2010. Both prescription and nonprescription (OTC) NSAIDs are available in the US.
Non-Prescription (OTC) NSAIDs
Meloxicam is available only through a doctor’s prescription. Like other NSAIDs, it reduces pain and swelling (inflammation). It does so by blocking enzymes involved in the production of prostaglandins. The enzymes are called cyclooxygenase 1 (COX-1) and cyclooxygenase 2 (COX-2). All oxicam NSAIDs block both COX-1 and COX-2. However, meloxicam blocks COX-2 more than COX-1.
When body tissue is injured or exposed to an infectious agent, the body produces prostaglandins. Prostaglandins play a central role in inflammation and pain. Thus, reducing prostaglandin production can help relieve pain and swelling, especially in the joints.
A Timeline of Approved Products and Uses
The US FDA approved conventional (7.5 mg and 15 mg) oral tablets for the management of signs and symptoms of osteoarthritis (OA). Brand name: Mobic.
June 1, 2004
The FDA approved Mobic oral suspension containing 7.5 mg of the drug per 5 ml.
October 22, 2015
The FDA approved oral capsules for the management of OA pain. Brand name: Vivlodex.
October 19, 2018
The FDA approved orally disintegrating tablets. The approved uses include the treatment of pain and swelling due to OA and rheumatoid arthritis (RA). Brand name: Qmiiz ODT.
Is Meloxicam a Controlled Substance?
Doctors prescribe meloxicam for patients who have arthritis. Arthritis causes pain and swelling in the joints. It’s used to treat the symptoms of two common types of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA).
The drug may also be used as a non-opioid alternative to pain medications. A doctor may use it before starting an opioid taper. This can help reduce the severity of opioid withdrawal symptoms. However, the U.S. FDA has not approved meloxicam for treating opioid withdrawal. The method of use depends on the formulation you take. There are three formulations currently available on the market. They are:
•Conventional (immediate-release) oral tablets.
Brand name: Mobic tablets 7.5 mg and 15 mg.
Brand name: Mobic oral suspension 7.5 mg/5 mL.
•Orally disintegrating tablets.
Brand name: Qmiiz ODT 7.5 mg and 15 mg.
A formulation containing 15 mg meloxicam and Duraflex topical gel (Comfort Pac) is no longer available in the U.S. since July 2018.
Studies have found that:
•For the treatment of osteoarthritis, 7.5 mg and 15 mg per day is as effective as diclofenac 100 mg per day and piroxicam 20 mg per day. All these medications had similar effects on relieving pain, reducing joint stiffness, and improving the quality of life.
•For rheumatoid arthritis, 7.5 mg per day is as effective as naproxen 750 mg per day. Interestingly, a few studies suggest 15 mg may be more effective than 7.5 mg for reducing morning pain. Using higher doses rarely provides any added benefits. Moreover, using higher doses can increase the risk of side effects.
Is Meloxicam Addictive?
Three Stages of Addiction
Can You Abuse It?
While meloxicam is not addictive, the drug may still be abused. Drug abuse refers to any use other than recommended. It could involve using the drug for a longer duration, in higher doses, or for conditions other than prescribed by your doctor.
Complications of long-term use of NSAIDs (OTC + prescription) contribute to 103,000 hospitalizations and 16,500 deaths each year.
Abusing the drug can cause:
•A burning sensation in the chest
Long-term abuse significantly increases the risk of:
•A heart attack and/pr stroke that may cause death
•Bleeding in the stomach and intestines
•Liver damage (in rare cases)
About 7% of patients taking the drug have abnormal levels of liver enzymes. In severe cases, it may cause inflammation of the liver and jaundice.
Meloxicam is not a narcotic. Narcotics help reduce pain by blocking pain signals in the brain. Meloxicam is a type of anti-inflammatory drug (NSAID). NSAIDs help control pain by blocking enzymes involved in the production of substances that cause pain and swelling.
Can You Overdose on Meloxicam?
Meloxicam overdose is not as common as other drug overdoses. There is also a scarcity of information on overdose numbers. Case reports suggest that people who took 6 to 10 times the maximum doses have recovered with no long-term effects.
In one recent study, researchers found that over 40% of people who used ibuprofen and meloxicam exceeded the daily limit of meloxicam (15 mg). Nonetheless, these findings should be interpreted with caution, as the study involved only 1,326 participants.
An overdose can cause serious damage to the heart and other vital organs. The signs and symptoms of an overdose can include:
•Severe pain and bleeding in the stomach
•Loss of liver function
•A heart attack
•High blood pressure
•Slowed or stopped breathing
•Swelling of the areas near your eyes, face, lips, or tongue
•Blue discoloration of the lips or skin
Is It Safe?
Any drug product with FDA-approved use is safe. A medication becomes available in the market only after it has passed several safety tests in both humans and animals. That said, certain drugs might cause potentially fatal effects if you do not use them properly, such as opioid pain medications, sleeping pills, and drugs used to treat muscle pain.
The FDA continues to monitor the safety of drugs even after the drugs have reached the market. Experts call this postmarketing surveillance.
Some approved drugs may show toxicity during postmarketing surveillance. For example, Rofecoxib (Vioxx), a drug similar to meloxicam, was found to increase the risk of heart disease. The manufacturer of Vioxx (Merck) withdrew the drug product from the market more than five years after the product first became available on the market.
Two factors determine the safety of a drug:
•Patient factors such as the pattern of use and compliance with a doctor’s instructions
•Drug factors such as strength and potency. Some drugs are very powerful. If you take more than the recommended doses, these drugs can cause death.
Meloxicam has shown an excellent safety profile in various clinical studies. Since its approval in 2000, there have been no documented reports of death because of its use. If a person intentionally abuses or overdoses on any drug, such an event is not considered a result of the drug’s poor safety profile.
Moreover, meloxicam is available only on a doctor’s prescription. This means your doctor has already determined the doses and duration of use that best meets your needs. When used as prescribed, meloxicam is safe and effective for treating pain in arthritis.
So far, postmarketing surveillance has found no serious effects.
Short-Term Effects of Meloxicam
•Swelling of the linings of the mouth and lips
Long-Term Effects of Meloxicam
•Elevated blood pressure
•Yellowish skin (jaundice)
•Swelling of the feet of legs
•Rapid weight gain
•Abnormal liver function test results
In some people, meloxicam can cause potentially life-threatening allergy. Severe allergic reactions are more likely to occur if you have a known allergy to other medications of the NSAID class. Seek emergency medical help if you have any of the following:
•Rapid shallow breathing
•Swelling of the areas near the eyes
How Do You Treat Meloxicam Abuse?
Meloxicam abuse rarely requires treatment. Adequate counseling and monitoring can help reduce the risk of abuse in most cases. Notably, people who use meloxicam are more likely to use other pain medications (including opioids) to curb pain. Prescription opioids have high abuse potential.
Moreover, people who have a long-term disease like arthritis may have co-occurring mental illnesses, such as depression and anxiety. People with rheumatoid arthritis are two to four times more likely to have a severe form of depression.
Both ongoing pain and depression significantly increase the chances of abusing a drug. About 1 in 5 Americans with depression or anxiety abuses alcohol or other addictive substances, according to the Anxiety and Depression Association of America. Thus, treatment may be necessary for other forms of drug abuse in people who misuse meloxicam.
- ClinCalc. Meloxicam Drug Usage Statistics, United States, 2006 – 2016.
- Oxford Academic. Military Medicine. Widespread Use of Prescription Nonsteroidal Anti-Inflammatory Drugs Among U.S. Army Active Duty Soldiers.
- Medscape. Nonsteroidal Anti-inflammatory Drug (NSAID) Toxicity.
- Alzheimer Disease and Associated Disorders. NSAID use and incident cognitive impairment in a population-based cohort.
- US FDA. Center for Drug Evaluation and Research.
- Expert Opinion on Pharmacotherapy. Meloxicam.
- ScienceDaily. Study Shows Long-term Use Of NSAIDs Causes Severe Intestinal Damage.
- LiverTox. Clinical and Research Information on Drug-Induced Liver Injury. Meloxicam.
- Pharmacoepidemiology and Drug Safety. Exceeding the daily dosing limit of nonsteroidal anti-inflammatory drugs among ibuprofen users.
- Monitor (Associates of Clinical Pharmacology). Postmarketing Research and Surveillance Issues and Challenges.
- International Journal of Clinical Rheumatology. Depression in patients with rheumatoid arthritis: description, causes and mechanisms.
- Anxiety and Depression Association of America. Substance Use Disorders.
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