Meloxicam Uses, Dosage, Side Effects & Warnings | DrugsAtlas
Authoritative Clinical Reference
Navigation
Therapeutic Class
Non-steroidal Anti-inflammatory Drug (NSAID)
Subclass
Preferential COX-2 inhibitor (Oxicam derivative)
Speciality
Pain Medicine
Schedule (India)
Schedule H
Routes
Oral, Intramuscular
Formulations
- Tablets: 7.5 mg, 15 mg
- Oral suspension: 7.5 mg/5 mL (limited availability)
- Injection (IM): 15 mg/1.5 mL ampoule
Adult indications
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
1. Osteoarthritis — Symptomatic Relief
Adults:
| Parameter | Recommendation |
|---|---|
| Starting dose | 7.5 mg orally once daily |
| Titration | May increase to 15 mg once daily after 1–2 weeks if inadequate response |
| Usual maintenance dose | 7.5 mg once daily |
| Maximum dose | 15 mg/day |
Clinical notes:
- Use lowest effective dose for shortest possible duration
- Administer with or after food to reduce GI irritation
- Once-daily dosing due to long half-life (~20 hours)
2. Rheumatoid Arthritis — Symptomatic Relief
Adults:
| Parameter | Recommendation |
|---|---|
| Starting dose | 7.5 mg orally once daily |
| Titration | May increase to 15 mg/day based on clinical response |
| Usual maintenance dose | 15 mg once daily |
| Maximum dose | 15 mg/day |
Clinical notes:
- IM injection (15 mg) may be used for acute flares — limit to 1–2 days only
- Continue DMARDs as primary therapy; meloxicam for symptomatic relief only
3. Ankylosing Spondylitis
Adults:
| Parameter | Recommendation |
|---|---|
| Starting dose | 15 mg orally once daily |
| Titration | May reduce to 7.5 mg/day once disease activity controlled |
| Usual maintenance dose | 15 mg once daily |
| Maximum dose | 15 mg/day |
Clinical notes:
- NSAIDs are first-line for symptom control in axial spondyloarthritis
- IM form may be used short-term during acute exacerbations
- Assess response after 2–4 weeks of continuous therapy
Secondary Indications — Adults Only (Off-label)
| Indication | Dose | Duration | Notes |
|---|---|---|---|
| Acute musculoskeletal pain / Low back pain — OFF-LABEL | 7.5–15 mg orally once daily | 5–7 days | Commonly used in Indian orthopaedic and general practice; avoid prolonged use |
| Acute shoulder pain (rotator cuff tendinitis) — OFF-LABEL | 7.5–15 mg orally once daily | 7–14 days | IM use: Specialist only, limit to 1–2 doses |
| Primary dysmenorrhoea — OFF-LABEL | 7.5 mg once daily | 3–5 days from onset of pain | Limited evidence; slower onset than ibuprofen — may not be ideal for acute relief |
Paediatric indications'
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
Not approved for routine paediatric use in India.
Secondary Indications — Paediatrics (Off-label)
| Indication | Age | Dose | Duration | Notes |
|---|---|---|---|---|
| Juvenile Idiopathic Arthritis — OFF-LABEL | ≥2 years | 0.125 mg/kg once daily | Long-term; reassess periodically | Specialist only (paediatric rheumatologist); supported by international paediatric data |
| Maximum dose | — | 7.5 mg/day | — | Do not exceed regardless of weight |
Paediatric Safety Statement
⚠️ Not recommended in children <2 years. Use in children 2–17 years only under paediatric rheumatology supervision.
Monitoring requirements:
- Baseline and periodic renal function, LFTs
- Monitor for GI symptoms, growth parameters
- Avoid in children with active peptic ulcer disease, renal or hepatic impairment
Renal Adjustments
| eGFR (mL/min/1.73m²) | Recommendation |
|---|---|
| >60 | No dose adjustment required |
| 30–60 | Use with caution; start at 7.5 mg/day; monitor renal function |
| 15–30 | Avoid if possible; if essential, use lowest dose with close monitoring |
| <15 or dialysis |
CONTRAINDICATED — high risk of further renal deterioration
|
Clinical note: All NSAIDs can cause sodium and fluid retention; assess volume status before prescribing.
Hepatic adjustment
Contraindications
- Active peptic ulcer disease or gastrointestinal bleeding
- History of GI bleeding or perforation related to previous NSAID therapy
- Known hypersensitivity to meloxicam, aspirin, or any NSAID
- NSAID-induced asthma, urticaria, or rhinitis (aspirin triad/Samter's triad)
- Severe hepatic impairment or active hepatic disease
- Severe renal impairment (eGFR <15 mL/min) or dialysis-dependent patients
- Severe heart failure (NYHA Class III–IV)
- Third trimester of pregnancy
- Perioperative period in coronary artery bypass graft (CABG) surgery
- Concurrent use with other NSAIDs (including low-dose aspirin for cardioprotection — relative)
- Active inflammatory bowel disease (ulcerative colitis, Crohn's disease)
Cautions
- History of gastrointestinal ulceration, bleeding, or perforation
- Established cardiovascular disease, cerebrovascular disease, or peripheral arterial disease
- Uncontrolled hypertension
- Ischaemic heart disease or heart failure (NYHA Class I–II)
- Elderly patients (>65 years) — increased risk of GI bleeding and renal impairment
- Concurrent use of corticosteroids, anticoagulants, or antiplatelet agents
- Dehydration or volume depletion — correct before initiating
- Chronic kidney disease (eGFR 30–60 mL/min)
- Mild-moderate hepatic impairment
- Asthma (may exacerbate bronchospasm)
- Coagulation disorders or thrombocytopenia
- SLE and mixed connective tissue disease (increased risk of aseptic meningitis — rare)
- Smoking and alcohol use (increased GI risk)
Pregnancy
| Aspect | Guidance |
|---|---|
| Overall safety | Avoid throughout pregnancy if possible |
| First trimester | Limited human data; potential risk of miscarriage and cardiac malformations; avoid unless essential |
| Second trimester | Use only if clearly necessary and no alternatives; short-term at lowest dose |
| Third trimester |
CONTRAINDICATED — risk of premature closure of ductus arteriosus, oligohydramnios, delayed labour, neonatal renal impairment
|
| Preferred alternatives | Paracetamol (analgesic of choice throughout pregnancy) |
| Monitoring | If inadvertently exposed in second trimester — fetal echocardiography, amniotic fluid assessment |
Lactation
| Aspect | Guidance |
|---|---|
| Compatibility | Probably compatible; low levels detected in breast milk |
| Drug levels in milk | Low (relative infant dose <1%) |
| Preferred alternatives | Paracetamol; ibuprofen (if NSAID required — more safety data) |
| Infant monitoring | Observe for GI disturbance, poor feeding, unusual drowsiness |
| Recommendation | Use lowest effective dose for shortest duration if required |
Elderly
| Aspect | Recommendation |
|---|---|
| Starting dose | 7.5 mg once daily |
| Titration | Avoid increasing to 15 mg unless essential; reassess after 1–2 weeks |
| Maximum recommended dose | 7.5 mg/day preferred; 15 mg/day only if clearly necessary |
| Extra risks | GI bleeding and perforation (4-fold higher risk vs younger adults), acute kidney injury, fluid retention, exacerbation of heart failure, hypertension, confusion |
| Duration | Use shortest possible duration; reassess need regularly |
| Gastroprotection | Co-prescribe PPI (e.g., pantoprazole 40 mg/day) in all elderly patients on NSAID therapy |
Major drug interactions
| Interacting Drug | Effect | Mechanism | Management |
|---|---|---|---|
| Warfarin / Acenocoumarol | Significantly increased bleeding risk; potential INR elevation | Inhibition of platelet aggregation + possible displacement from protein binding |
Avoid if possible; if essential, monitor INR closely (within 3–5 days of starting)
|
| Low-dose Aspirin | Reduced cardioprotective effect of aspirin; increased GI bleeding | COX-1 competition at platelet level | Avoid long-term combination; if essential, take aspirin 2 hours before meloxicam |
| Other NSAIDs | Additive GI and renal toxicity | Synergistic COX inhibition |
Avoid concurrent use
|
| Methotrexate | Increased methotrexate toxicity (myelosuppression, hepatotoxicity) | Reduced renal clearance of methotrexate |
Avoid with high-dose methotrexate; if using low-dose (RA), monitor closely
|
| Lithium | Lithium toxicity (tremor, confusion, arrhythmias) | Reduced renal lithium clearance |
Avoid if possible; if essential, reduce lithium dose by 20–30% and monitor levels
|
| ACE inhibitors / ARBs + Diuretics ("Triple whammy") | Acute kidney injury | Additive renal hypoperfusion |
Avoid triple combination; if unavoidable, monitor creatinine closely
|
| Ciclosporin / Tacrolimus | Increased nephrotoxicity | Additive renal vasoconstriction | Avoid combination; if essential, monitor renal function frequently |
Moderate drug interactions
| Interacting Drug | Effect | Management |
|---|---|---|
| ACE inhibitors / ARBs (alone) | Blunted antihypertensive effect; increased renal risk | Monitor BP and renal function; ensure adequate hydration |
| Diuretics (loop/thiazide) | Reduced diuretic efficacy; increased nephrotoxicity risk | Monitor BP, weight, renal function |
| Beta-blockers | Reduced antihypertensive effect | Monitor BP |
| Corticosteroids | Increased GI ulceration and bleeding risk | Co-prescribe PPI for gastroprotection |
| SSRIs / SNRIs | Increased GI bleeding risk | Monitor for bleeding; consider gastroprotection |
| Quinolones (ciprofloxacin, levofloxacin) | Increased seizure risk (rare) | Use with caution in patients with seizure history |
| Antidiabetic agents (sulfonylureas) | Possible enhanced hypoglycaemic effect | Monitor blood glucose |
| Phenytoin | Possible increased phenytoin levels | Monitor phenytoin levels if symptoms of toxicity |
Common Adverse effects
- Dyspepsia, epigastric pain
- Nausea, vomiting
- Diarrhoea or constipation
- Abdominal discomfort
- Headache
- Dizziness
- Peripheral oedema
- Skin rash
- Elevated liver transaminases (usually transient)
- Pruritus
Serious Adverse effects
| Adverse Effect | Clinical Notes |
|---|---|
| GI bleeding, ulceration, or perforation |
May occur without warning symptoms; higher risk in elderly, previous GI history, concurrent corticosteroids/anticoagulants — discontinue immediately
|
| Cardiovascular events | Increased risk of MI, stroke with prolonged high-dose use; avoid in established CVD |
| Acute kidney injury |
Especially in dehydrated, elderly, or those on ACEi/ARBs/diuretics — discontinue and hydrate
|
| Hepatotoxicity |
Rare; may present as jaundice, elevated LFTs — discontinue if significant elevation
|
| Stevens-Johnson Syndrome / TEN |
Very rare; usually within first month — discontinue immediately; hospitalise
|
| Anaphylaxis / Angioedema |
May occur in NSAID-sensitive individuals — emergency management required
|
| Severe skin reactions (DRESS, exfoliative dermatitis) |
Rare — discontinue immediately
|
| Agranulocytosis, aplastic anaemia | Very rare; monitor if unexplained infection or bruising |
| Aseptic meningitis | Rare; especially in SLE patients |
Monitoring requirements
| Phase | Parameters |
|---|---|
| Baseline | Serum creatinine, eGFR, LFTs, BP, haemoglobin, history of GI disease and CV risk factors |
| After initiation (1–2 weeks) | Reassess GI symptoms, BP, renal function in high-risk patients (elderly, CKD, on ACEi/diuretics) |
| Long-term use | Renal function and LFTs every 3–6 months; BP monitoring; assess for GI symptoms at each visit; periodic haemoglobin if prolonged use |
| Special populations | More frequent monitoring in elderly, renal impairment, cardiovascular disease |
Brands in India
- Muvera® (Glenmark)
- Movon® (Micro Labs)
- Melflam® (Ipca)
- Mobic® (Boehringer Ingelheim — limited)
- Melokem® (Alkem)
- Meloxicam-Ranbaxy® (Sun Pharma)
- Melonex® (Zydus)
- Flexicam® (Lupin)
- Multiple generic formulations widely available
FDC note: Fixed-dose combinations with paracetamol available (e.g., Movon-P®) — use cautiously; generally monotherapy preferred.
Price range (INR)
| Formulation | Approximate Price |
|---|---|
| Tablets 7.5 mg | ₹3–8 per tablet |
| Tablets 15 mg | ₹5–12 per tablet |
| IM Injection 15 mg/1.5 mL | ₹12–25 per ampoule |
| Oral suspension (if available) | ₹40–70 per 60 mL bottle |
NLEM 2022 Status:Listed (Meloxicam 7.5 mg and 15 mg tablets) — NPPA price controlled
Availability: Widely available in private sector; government supply variable
Clinical pearls
- COX-2 preference offers modest GI advantage over non-selective NSAIDs (ibuprofen, diclofenac), but GI risk is not eliminated — always assess and consider PPI co-prescription in at-risk patients
- Not suitable for acute pain requiring rapid relief (e.g., acute gout, renal colic) due to slower onset of action (~1 hour, peak at 5–6 hours) — consider indomethacin or ketorolac for acute flares
- Once-daily dosing improves compliance — long half-life (~20 hours) allows single daily administration
- IM injection should be limited to 1–2 doses — transition to oral as soon as feasible; no proven benefit of prolonged parenteral use
- "Triple whammy" combination (NSAID + ACEi/ARB + diuretic) is a common cause of preventable AKI — avoid in elderly and CKD patients
- CV risk is a class effect — use lowest dose for shortest duration; reassess need at each visit in patients with CV risk factors
Version
RxIndia v1.0 — 25 Apr 2024
Reference
- CDSCO approved product information
- Indian Pharmacopoeia
- National List of Essential Medicines (NLEM) 2022
- API Textbook of Medicine
- AIIMS Internal Medicine and Rheumatology Protocols
- ICMR Guidelines on Rheumatic Diseases
- Indian Rheumatology Association practice recommendations
- Indian Orthopaedic Association treatment protocols (hospital-based)
⚖️
Clinical Responsibility
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
Content Feedback
Is this information helpful?
Help us improve our clinical database for the medical community.