Drug Monograph
Meloxicam (Mobic)
meloxicam
Pharmacokinetic Profile
Half-Life
15–20 h
Metabolism
CYP2C9 (major); CYP3A4 (minor)
Protein Binding
~99.4% (albumin)
Bioavailability
89% (absolute)
Volume of Distribution
~10 L (Vss)
Clinical Information
Drug Class
Preferential COX-2 inhibitor (oxicam)
Available Doses
7.5 mg, 15 mg tablets; 7.5 mg/5 mL suspension
Route
Oral (tablet, suspension); also IV (Anjeso 30 mg)
Renal Adjustment
Avoid in severe impairment; max 7.5 mg/day on haemodialysis
Hepatic Adjustment
No adjustment for mild–moderate; severe (Child-Pugh C) not studied
Pregnancy
Avoid ≥30 weeks; limit use 20–30 weeks
Lactation
No human data; other agents preferred (ibuprofen, celecoxib)
Schedule / Legal Status
Rx only (all strengths)
Black Box Warning
Yes — CV thrombotic events & GI bleeding
Generic Available
Yes (widely available)
Indications
| Indication | Approved Population | Therapy Type | Status |
|---|---|---|---|
| Osteoarthritis | Adults | Monotherapy | FDA Approved |
| Rheumatoid arthritis | Adults | Monotherapy or adjunctive with DMARDs | FDA Approved |
| Juvenile rheumatoid arthritis (pauciarticular & polyarticular) | ≥2 years (suspension); ≥60 kg (tablets) | Monotherapy or adjunctive | FDA Approved |
Meloxicam is a preferential (but not fully selective) COX-2 inhibitor belonging to the oxicam class of NSAIDs. At therapeutic doses, it inhibits COX-2 to a greater extent than COX-1, positioning it between fully selective coxibs like celecoxib and non-selective agents like naproxen. Its long half-life of 15–20 hours enables convenient once-daily dosing. Meloxicam was the 27th most commonly prescribed medication in the United States in 2023, with over 20 million prescriptions. Unlike celecoxib, meloxicam is not a sulfonamide and has no sulfonamide allergy contraindication.
Off-Label Uses
Acute gout flares — Meloxicam 15 mg daily has been used for acute gout, though it lacks the rapid-onset advantage of indomethacin or naproxen. Evidence quality: Low.
Perioperative analgesia (ERAS protocols) — Oral or IV meloxicam (Anjeso 30 mg IV) is used as part of multimodal opioid-sparing strategies in surgical settings. Evidence quality: Moderate.
Chronic low back pain — NSAIDs including meloxicam are recommended as first-line pharmacotherapy by ACP guidelines. Evidence quality: Moderate.
Dosing
Adult Dosing by Clinical Scenario
| Clinical Scenario | Starting Dose | Maintenance Dose | Maximum Dose | Notes |
|---|---|---|---|---|
| Osteoarthritis — chronic symptom management | 7.5 mg once daily | 7.5–15 mg once daily | 15 mg/day | Titrate to 15 mg/day if additional benefit required; may be taken without regard to meals Use lowest effective dose for shortest duration |
| Rheumatoid arthritis — active disease | 7.5 mg once daily | 7.5–15 mg once daily | 15 mg/day | Adjust dose based on clinical response; does not alter disease course — use alongside DMARDs Once-daily dosing supported by 15–20 h half-life |
| Haemodialysis patients | 7.5 mg once daily | 7.5 mg once daily | 7.5 mg/day | Maximum 7.5 mg/day; meloxicam is not dialysable Avoid in severe renal impairment not on dialysis |
Pediatric Dosing
| Clinical Scenario | Starting Dose | Maintenance Dose | Maximum Dose | Notes |
|---|---|---|---|---|
| JRA (≥2 years, oral suspension) | 0.125 mg/kg once daily | 0.125 mg/kg once daily | 7.5 mg/day | Weight-based dosing using oral suspension (7.5 mg/5 mL); no additional benefit at higher doses in paediatric trials Suspension contains sorbitol — do not co-administer with sodium polystyrene sulfonate (risk of intestinal necrosis) |
| JRA (≥60 kg, Mobic tablets) | 7.5 mg once daily | 7.5 mg once daily | 7.5 mg/day | Tablets should not be used in children <60 kg; no additional benefit from 15 mg in clinical trials Tablets are NOT interchangeable with other meloxicam formulations at same mg strength |
Clinical Pearl: Formulation Non-Interchangeability
Mobic tablets have not demonstrated equivalent systemic exposure to other approved oral meloxicam formulations (including Vivlodex capsules 5/10 mg and generic capsules), even when the milligram strength is the same. Different formulations should not be substituted for one another. Vivlodex, a lower-dose formulation using SoluMatrix Fine Particle Technology, is approved only for OA pain at 5–10 mg/day — different from Mobic’s 7.5–15 mg/day range. Always verify which formulation the patient is receiving.
Special Population Adjustments
| Population | Adjustment | Rationale |
|---|---|---|
| Mild–moderate hepatic impairment | No dose adjustment required | PK not significantly altered in Child-Pugh I–II; protein binding unaffected |
| Severe hepatic impairment (Child-Pugh C) | Not adequately studied; use with caution | No controlled data available |
| Severe renal impairment | Not recommended | Metabolites excreted renally; may hasten renal dysfunction |
| Haemodialysis | Max 7.5 mg/day | Meloxicam is not dialysable; dose cap based on PK data |
| Elderly (≥65 years) | Start at 7.5 mg; elderly females have 47% higher AUC vs younger females | Increased GI, CV, and renal risk; elderly females show higher exposure (vs younger females) but similar adverse event profile to elderly males |
Pharmacology
Mechanism of Action
Meloxicam is an enolic acid (oxicam) derivative that preferentially inhibits cyclooxygenase-2 (COX-2) over COX-1 at therapeutic concentrations, though it is not as COX-2 selective as celecoxib. This preferential COX-2 inhibition reduces inflammatory prostaglandin synthesis at sites of pain and inflammation while producing somewhat less disruption of COX-1-mediated gastroprotective prostaglandins than fully non-selective agents. However, at higher doses, this selectivity diminishes. Meloxicam also demonstrates analgesic and antipyretic activity through peripheral and central prostaglandin synthesis inhibition. A notable pharmacokinetic feature is biliary recycling, which produces a secondary plasma concentration peak at 12–14 hours post-dose and contributes to its extended duration of action.
ADME Profile
| Parameter | Value | Clinical Implication |
|---|---|---|
| Absorption | Bioavailability 89% (absolute); Tmax 4–5 h (fasted), 5–6 h (with food); high-fat meal increases Cmax ~22% but does not affect AUC; linear PK across 7.5–30 mg | Almost complete absorption; may be taken with or without food; prolonged absorption due to low solubility contributes to extended half-life; antacids do not affect absorption |
| Distribution | Vss ~10 L; ~99.4% albumin-bound (decreases to ~99% in renal disease); synovial fluid penetration 40–50% of plasma; RBC penetration <10% | Low Vd indicates confinement primarily to plasma; high synovial fluid penetration supports efficacy for joint inflammation; free fraction increases in renal impairment |
| Metabolism | CYP2C9 (major) and CYP3A4 (minor) to 5’-hydroxymethyl metabolite, then to 5’-carboxymethyl metabolite; 4 inactive metabolites total; biliary recycling produces secondary plasma peak at 12–14 h | CYP2C9 polymorphisms may alter exposure (caution in poor metabolisers); CYP2C9 inhibitors (e.g., fluconazole, voriconazole) increase meloxicam AUC; cholestyramine accelerates elimination |
| Elimination | t½ 15–20 h; clearance 7–9 mL/min; excreted equally in urine and faeces (as metabolites); <0.25% unchanged in urine; steady state in 3–5 days; not dialysable | Long half-life supports once-daily dosing; steady state in <1 week; metabolite accumulation possible in renal impairment; gender variation: females t½ ~19.5 h vs males ~23.4 h (single dose); clinically insignificant |
Side Effects
Data from Phase 2/3 trials including 10,122 OA patients and 1,012 RA patients at 7.5 mg/day, and 3,505 OA and 1,351 RA patients at 15 mg/day. Most common adverse events (≥5% and greater than placebo) were diarrhoea, upper respiratory tract infections, dyspepsia, and influenza-like symptoms (FDA PI, revised 11/2024). Note: headache was reported at 7.8–8.3% but was lower than placebo (10.2%) and is not considered drug-related.
2–10%
Common (≥2% in Controlled OA/RA Trials)
| Adverse Effect | Incidence (7.5 mg / 15 mg) | Clinical Note |
|---|---|---|
| Diarrhoea | 7.8% / 3.2% (vs 3.8% placebo, OA trial) | More common at 7.5 mg in OA trial; evaluate for GI complications if persistent or bloody |
| Upper respiratory tract infection | 3.2% / 1.9% (OA); 7.0% / 6.5% (RA) (vs 1.9% OA; 4.1% RA placebo) | Consistently elevated across trials; usually self-limiting |
| Dyspepsia | 4.5% / 4.5% (OA); 5.8% / 4.0% (RA) (vs 4.5% OA; 3.8% RA placebo) | Lower than diclofenac (6.5%) in head-to-head OA comparisons; co-prescribe PPI if high-risk |
| Influenza-like symptoms | 4.5% / 5.8% (OA); 2.9% / 2.3% (RA) (vs 5.1% OA; 2.1% RA placebo) | Borderline difference from placebo; may overlap with underlying inflammatory disease symptoms |
| Peripheral edema | 1.9% / 4.5% (vs 2.5% placebo, OA trial) | Dose-related (4.5% at 15 mg); monitor weight and BP; use caution in heart failure |
| Nausea | 3.9% / 3.8% (OA); 3.3% / 3.8% (RA) (vs 3.2% OA; 2.6% RA placebo) | Marginally higher than placebo; take with food if troublesome |
| Abdominal pain | 1.9% / 2.6% (OA); 2.9% / 2.3% (RA) (vs 2.5% OA; 0.6% RA placebo) | Evaluate if persistent or worsening; may signal developing ulceration |
| Dizziness | 2.6% / 3.8% (vs 3.2% placebo, OA trial) | Similar to or less than placebo in OA; advise caution with driving at initiation |
| Flatulence | 3.2% / 3.2% (vs 4.5% placebo, OA trial) | Lower than placebo; NSAID class effect; generally mild |
| Rash | 2.6% / 0.6% (OA); 1.0% / 2.1% (RA) (vs 2.5% OA; 1.7% RA placebo) | Discontinue immediately if progressing; evaluate for SJS/TEN/DRESS |
Serious
Serious Adverse Effects (Regardless of Frequency)
| Adverse Effect | Estimated Frequency | Typical Onset | Required Action |
|---|---|---|---|
| Cardiovascular thrombotic events (MI, stroke) | NSAID class risk; may begin early in treatment | First weeks; increases with dose and duration | Use lowest effective dose for shortest duration; avoid post-CABG; monitor CV symptoms |
| GI bleeding, ulceration, perforation | ~1% at 3–6 months; 2–4% at 1 year (NSAID class) | Any time; without warning | Discontinue immediately; urgent endoscopy; haemodynamic support |
| Hepatotoxicity (severe) | Rare; ALT/AST ≥3× ULN in ~1%; <3× ULN in up to 15% | Weeks to months | Discontinue if symptomatic or ≥3× ULN; hepatic workup |
| Acute kidney injury / renal papillary necrosis | Uncommon; higher in dehydrated/elderly or with concurrent nephrotoxics | Days to weeks | Discontinue; IV hydration; monitor creatinine; correct volume status before initiating |
| Severe skin reactions (SJS, TEN, FDE/GBFDE, DRESS) | Very rare | 1–8 weeks; FDE may recur at same site | Discontinue immediately; dermatology referral; permanent discontinuation; FDE added to PI 11/2024 |
| Anaphylactoid reactions | Very rare | Minutes to hours | Emergency management; permanent discontinuation |
| Heart failure exacerbation | ~2-fold increased hospitalisation (NSAID class) | Days to weeks | Avoid in severe HF; monitor fluid balance; discontinue if decompensation |
| Agranulocytosis | Very rare (postmarketing) | Variable | Discontinue; CBC with differential; haematology referral |
Discontinuation
Discontinuation Context
Overall Tolerability
Generally well tolerated
GI event rates were comparable to or lower than non-selective NSAIDs in controlled OA/RA trials. Specific discontinuation percentages are not individually reported in the PI, but GI complaints (dyspepsia, abdominal pain, diarrhoea) were the most common reason for treatment cessation.
Comparative Context
Favourable GI profile
In head-to-head OA comparisons, overall GI adverse events at 15 mg/day (17.3%) were lower than diclofenac 100 mg/day (28.1%) and comparable to placebo (17.2%).
Fixed Drug Eruption (FDE) — New PI Warning (11/2024)
The FDA updated the meloxicam label in November 2024 to include fixed drug eruption (FDE) and its severe variant, generalised bullous FDE (GBFDE), as a potential serious skin reaction. FDE typically presents as recurring well-demarcated erythematous or violaceous patches at the same anatomical site with each drug re-exposure. GBFDE can be life-threatening. Discontinue meloxicam immediately if FDE is suspected and do not rechallenge.
Drug Interactions
Meloxicam is a CYP2C9 substrate with minor CYP3A4 involvement. It undergoes biliary recycling which is accelerated by cholestyramine. Meloxicam does not significantly affect the pharmacokinetics of warfarin or methotrexate at standard doses, but pharmacodynamic interactions (bleeding, renal) remain clinically important.
MajorLithium
MechanismDecreased renal lithium clearance via prostaglandin inhibition
EffectIncreased serum lithium levels; risk of lithium toxicity
ManagementMonitor lithium levels when starting, adjusting, or stopping meloxicam; may need lithium dose reduction
FDA PIMajorWarfarin & oral anticoagulants
MechanismSynergistic bleeding risk from mucosal injury + anticoagulant effect; no significant PK interaction
EffectIncreased serious bleeding risk
ManagementMonitor INR closely; use lowest meloxicam dose; add PPI if high GI risk
FDA PIMajorPemetrexed
MechanismReduced renal clearance of pemetrexed by NSAIDs
EffectIncreased risk of pemetrexed-related myelosuppression, renal, and GI toxicity
ManagementHold meloxicam ≥5 days before, the day of, and ≥2 days after pemetrexed (CrCl 45–79 mL/min); avoid entirely if CrCl <45 mL/min
FDA PIModerateACE Inhibitors / ARBs / Beta-Blockers
MechanismReduced prostaglandin-mediated vasodilation and natriuresis
EffectBlunted antihypertensive effect; increased AKI risk in elderly/volume-depleted
ManagementMonitor blood pressure and renal function; ensure adequate hydration; avoid “triple whammy” combination
FDA PIModerateDiuretics (loop & thiazide)
MechanismProstaglandin inhibition reduces renal sodium and water excretion
EffectReduced natriuretic and antihypertensive efficacy
ManagementMonitor BP, weight, and renal function
FDA PIModerateSSRIs / SNRIs
MechanismReduced platelet serotonin + NSAID mucosal effect (additive)
EffectIncreased GI and other bleeding risk
ManagementCo-prescribe PPI in high-risk patients; educate on bleeding signs
FDA PIModerateCholestyramine
MechanismInterrupts biliary recycling of meloxicam by binding it in the gut
EffectIncreases meloxicam clearance by ~50%; shortens half-life
ManagementMay be used therapeutically to accelerate elimination in overdose; avoid concurrent use if full meloxicam effect is desired
FDA PIModerateAspirin
MechanismAspirin increases meloxicam AUC by 10% and Cmax by 24%; additive GI mucosal injury
EffectIncreased GI bleeding risk; modest increase in meloxicam exposure
ManagementConcurrent analgesic-dose aspirin not recommended; if low-dose aspirin required, add PPI and use lowest meloxicam dose
FDA PIMinorMethotrexate
MechanismNSAID class effect on renal MTX clearance; no displacement from protein binding (in vitro)
EffectNo significant PK interaction with single-dose MTX in studies; theoretical risk with high-dose MTX
ManagementMonitor for MTX toxicity (CBC, renal, LFTs) when co-prescribing; withhold around high-dose MTX
FDA PIMonitoring
- Blood PressureBaseline, 2–4 weeks, then periodically
RoutineNSAIDs including meloxicam can elevate BP. Monitor more frequently in patients on antihypertensives or with CV risk factors. - Renal FunctionBaseline, then q6–12 months
RoutineSerum creatinine, BUN, eGFR. Meloxicam metabolites are renally excreted. Check within 1–2 weeks in high-risk patients. - Hepatic FunctionBaseline; then if symptoms
Trigger-basedALT/AST elevation <3× ULN may occur in up to 15% of NSAID users; ≥3× ULN in ~1%. Discontinue if symptomatic or persistent elevation. - CBCBaseline; then if signs of anaemia or bleeding
Trigger-basedMonitor Hb/Hct for occult GI blood loss; agranulocytosis reported postmarketing (very rare). - GI SymptomsEvery visit
RoutineAsk about dyspepsia, abdominal pain, dark stools, haematemesis. Low threshold for endoscopy if new symptoms. - CV SymptomsEvery visit
RoutineScreen for chest pain, dyspnoea, fluid retention, oedema. Reassess risk-benefit periodically. - SkinEvery visit; urgently if rash
Trigger-basedScreen for fixed drug eruption (recurring patches at same site), SJS/TEN (blistering, mucosal erosion), and DRESS (fever, rash, eosinophilia).
Contraindications & Cautions
Absolute Contraindications
- Known hypersensitivity to meloxicam or any component, including history of anaphylaxis or serious skin reactions
- Aspirin-exacerbated respiratory disease (AERD) — history of asthma, urticaria, or allergic reactions after aspirin or other NSAIDs
- Peri-operative CABG surgery setting
- Pregnancy ≥30 weeks gestation — risk of premature ductus arteriosus closure and fetal renal dysfunction
- Previous serious skin reaction to any NSAID
Relative Contraindications (Specialist Input Recommended)
- Severe renal impairment — not recommended; metabolites excreted renally
- Active peptic ulcer or recent GI bleed — mandatory PPI if NSAID essential
- Severe heart failure (NYHA III–IV) — risk of decompensation
- Pregnancy 20–30 weeks — limit use; risk of oligohydramnios
- Concurrent pemetrexed (CrCl <45 mL/min) — contraindicated per PI
Use with Caution
- Elderly (≥65 years) — increased GI, CV, renal risk; start at 7.5 mg; elderly females have 47% higher AUC
- Known CV disease or risk factors — lowest dose, shortest duration
- Mild–moderate hepatic impairment — no dose change needed but monitor LFTs
- Concurrent anticoagulants, SSRIs, corticosteroids — additive bleeding risk
- Asthma (without aspirin sensitivity) — monitor for bronchospasm
- Dehydration or hypovolaemia — correct volume status before starting
FDA Boxed Warning
Risk of Serious Cardiovascular and Gastrointestinal Events
Cardiovascular Thrombotic Events: NSAIDs cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may begin early in treatment and increase with duration of use. Meloxicam is contraindicated in the setting of CABG surgery.
Gastrointestinal Bleeding, Ulceration, and Perforation: NSAIDs cause an increased risk of serious GI adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use without warning. Elderly patients and those with prior peptic ulcer disease or GI bleeding are at greater risk.
Patient Counselling
Purpose of Therapy
Meloxicam reduces pain, swelling, and stiffness caused by arthritis by blocking inflammatory chemicals in the body. It is taken once daily and is not a cure for arthritis but helps manage symptoms to improve daily functioning. Use at the lowest effective dose for the shortest time needed.
How to Take
Take once daily at the same time each day, with or without food. Swallow tablets whole with water. For children on oral suspension, measure carefully with the dosing syringe provided. Do not combine with other NSAID products (ibuprofen, naproxen, aspirin for pain). Different brands of meloxicam are not interchangeable even at the same dose.
Stomach Problems & GI Bleeding
Tell patientMeloxicam may be gentler on the stomach than some older anti-inflammatory drugs, but stomach bleeding can still occur, especially with alcohol, aspirin, or blood thinners. Take a stomach-protecting medicine (PPI) if prescribed.
Call prescriberBlack or tarry stools, vomiting blood or coffee-ground material, persistent stomach pain, unexplained weight loss.
Heart & Circulation Risks
Tell patientAll anti-inflammatory drugs carry a small risk of heart attack or stroke, even in people without heart disease. This risk is lower at lower doses and with shorter use.
Call prescriberChest pain, shortness of breath, sudden weakness or numbness on one side, slurred speech, or leg swelling.
Skin Reactions
Tell patientRarely, meloxicam can cause serious skin reactions including recurring patches at the same skin site (fixed drug eruption). Any new rash, blistering, or skin peeling should be reported immediately.
Call prescriberAny rash, blistering, peeling skin, mouth sores, or rash with fever. Seek emergency care if severe.
Kidney & Fluid Retention
Tell patientStay well-hydrated. Report swelling in hands, feet, or ankles, or any decrease in urine output. Rapid weight gain may indicate fluid retention.
Call prescriberRapid weight gain (>2 kg/week), significant swelling, decreased urine, fatigue, or confusion.
Pregnancy, Fertility & Breastfeeding
Tell patientMeloxicam must not be used after 30 weeks of pregnancy. It may affect fertility; this is usually reversible. There are no human data on transfer into breast milk — ibuprofen or celecoxib are preferred alternatives during breastfeeding.
Call prescriberIf pregnancy is confirmed or suspected; if planning to breastfeed.
Drug Interactions
Tell patientInform your doctor about all medications including over-the-counter products. Important interactions include blood thinners, blood pressure medicines, lithium, and antidepressants. Do not take other NSAIDs at the same time.
Call prescriberIf starting any new medication, or if you experience unusual bruising, bleeding, or feel unwell.
Sources
Regulatory (PI / SmPC)
- Mobic (meloxicam) tablets — Full Prescribing Information. Revised 11/2024. U.S. FDA Reference ID: 5482828. accessdata.fda.govPrimary source for all approved indications, dosing, adverse reactions (Tables 1a and 1b), contraindications, and boxed warning cited throughout this monograph.
- Meloxicam oral suspension — Full Prescribing Information. Revised 2024. accessdata.fda.govSource for suspension-specific data including JRA dosing (0.125 mg/kg/day) and sorbitol interaction with sodium polystyrene sulfonate.
- Vivlodex (meloxicam) capsules — Full Prescribing Information. dailymed.nlm.nih.govSource for low-dose SoluMatrix formulation data (5–10 mg); documents non-interchangeability with Mobic tablets.
Key Clinical Trials
- Nissen SE, Yeomans ND, Solomon DH, et al. Cardiovascular safety of celecoxib, naproxen, or ibuprofen for arthritis. N Engl J Med. 2016;375(26):2519–2529. doi:10.1056/NEJMoa1611593PRECISION trial: key NSAID cardiovascular safety comparator; meloxicam not directly studied but provides context for NSAID-class CV risk assessment.
- Bhala N, Emberson J, Merhi A, et al. (CNT Collaboration). Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs. Lancet. 2013;382(9894):769–779. doi:10.1016/S0140-6736(13)60900-9Individual participant data meta-analysis providing NSAID-class CV and GI risk estimates, including heart failure hospitalisation data.
- Hawkey C, Kahan A, Steinbrück K, et al. Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients. Br J Rheumatol. 1998;37(9):937–945. doi:10.1093/rheumatology/37.9.937MELISSA trial: large-scale GI tolerability comparison (N=9,323) demonstrating favourable GI profile of meloxicam 7.5 mg vs diclofenac 100 mg.
Guidelines
- Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis. Arthritis Care Res. 2020;72(2):149–162. doi:10.1002/acr.24131Conditionally recommends oral NSAIDs including meloxicam for OA; advises lowest effective dose and shortest duration.
- Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain. Ann Intern Med. 2017;166(7):514–530. doi:10.7326/M16-2367ACP guideline recommending NSAIDs as first-line pharmacotherapy for acute and chronic low back pain.
Mechanistic / Basic Science
- Engelhardt G, Homma D, Schlegel K, et al. Anti-inflammatory, analgesic, antipyretic and related properties of meloxicam. Inflamm Res. 1995;44(10):423–433. doi:10.1007/BF01757699Foundational pharmacological characterisation of meloxicam’s preferential COX-2 inhibition and GI tolerability in preclinical models.
- Chesné C, Guyomard C, Guillouzo A, et al. Metabolism of meloxicam in human liver involves cytochromes P4502C9 and 3A4. Xenobiotica. 1998;28(1):1–13. doi:10.1080/004982598239704In vitro study establishing CYP2C9 as the major and CYP3A4 as the minor enzyme in meloxicam biotransformation.
Pharmacokinetics / Special Populations
- Turck D, Roth W, Busch U. A review of the clinical pharmacokinetics of meloxicam. Br J Rheumatol. 1996;35(Suppl 1):13–16. doi:10.1093/rheumatology/35.suppl_1.13Definitive PK review covering absolute bioavailability (89%), Vd (~10 L), half-life (15–20 h), protein binding (~99.4%), and biliary recycling.
- Boulton DW, Kollia GD, Haber EB, Mojaverian P. Population pharmacokinetic analysis of meloxicam in rheumatoid arthritis patients. Br J Clin Pharmacol. 2002;53(3):333. doi:10.1046/j.1365-2125.2002.01557.xPopulation PK analysis confirming clearance 7–8 mL/min, t½ ~20 h, and effects of sulphasalazine and glucocorticoids on meloxicam clearance in RA.
- Bae JW, Kim JH, Choi CI, et al. Effects of CYP2C9*1/*13 on the pharmacokinetics and pharmacodynamics of meloxicam. Br J Clin Pharmacol. 2011;71(4):550–555. doi:10.1111/j.1365-2125.2010.03853.xDemonstrates that CYP2C9*1/*13 genotype decreases meloxicam metabolism by 62%, supporting pharmacogenomic caution in variant carriers.
- Meloxicam. In: Drugs and Lactation Database (LactMed). Bethesda, MD: National Institute of Child Health and Human Development; Updated Jul 15, 2025. ncbi.nlm.nih.govConfirms no human breastfeeding data available for meloxicam; recommends other agents (ibuprofen, celecoxib) as preferred alternatives.