Meloxicam

{{Short description|Nonsteroidal anti-inflammatory drug (NSAID)}} {{Guidebook|date=May 2025}} {{Use dmy dates|date=August 2025}} {{cs1 config|name-list-style=vanc|display-authors=6}} {{Infobox drug | Verifiedfields = changed | Watchedfields = changed | verifiedrevid = 459437267 | image = Meloxicam2DACS.svg | image_class = skin-invert-image | width = 200 | alt = | image2 = Meloxicam-from-xtal-3D-bs-17.png | image_class2 = bg-transparent | alt2 = | caption =

| pronounce = | tradename = Mobic, Meloxidyl, others | Drugs.com = {{drugs.com|monograph|meloxicam}} | MedlinePlus = a601242 | DailyMedID = Meloxicam | pregnancy_AU = C | pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{drugs.com|pregnancy|meloxicam}}</ref> | pregnancy_category = | routes_of_administration = By mouth, intravenous | class = Nonsteroidal anti-inflammatory drug (NSAID) | ATC_prefix = M01 | ATC_suffix = AC06 | ATC_supplemental = {{ATC|M01|AC56}}, {{ATC|N01|BB59}}

| legal_AU = S4 | legal_AU_comment = | legal_BR =  | legal_BR_comment = | legal_CA = Rx-only | legal_CA_comment = <ref>{{cite web | title = Health product highlights 2021: Annexes of products approved in 2021 | date = 3 August 2022 | website = Health Canada | url = https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/health-product-highlights-2021/appendices.html | access-date = 25 March 2024 }}</ref> | legal_DE =  | legal_DE_comment = | legal_NZ =  | legal_NZ_comment = | legal_UK = POM | legal_UK_comment = | legal_US = Rx-only | legal_US_comment = <ref name="Mobic FDA label">{{cite web | title = Mobic- meloxicam tablet | work = DailyMed | publisher = U.S. National Library of Medicine| url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=676e73fb-51d2-449a-8749-1a7bcc257b11 | access-date = 15 May 2021 }}</ref><ref name="Anjeso FDA label">{{cite web | title = Anjeso- meloxicam injection | work = DailyMed | publisher = U.S. National Library of Medicine| url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6f517ef8-9478-494e-adfd-4944b9900df4 | access-date = 15 May 2021 }}</ref><ref>{{cite web | title = Xifyrm- meloxicam injection | date = 18 June 2025 | work = DailyMed | publisher = U.S. National Library of Medicine| url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bf2b198c-0726-488a-b911-4fe394e4b56e | access-date = 6 July 2025 }}</ref> | legal_EU = Rx-only | legal_EU_comment = <ref>{{cite web | title = Loxitab EPAR | date = 8 September 2023 | website = European Medicines Agency (EMA) | url = https://www.ema.europa.eu/en/medicines/veterinary/EPAR/loxitab | access-date = 24 May 2024 }}</ref><ref>{{cite web | title = Metacam EPAR | date = 31 July 2006 | website = European Medicines Agency (EMA) | url = https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam | access-date = 3 December 2024 }}</ref><ref>{{cite web | title = Meloxidyl PI | date = 18 January 2007 | website = Union Register of medicinal products | url = https://ec.europa.eu/health/documents/community-register/html/v070.htm | access-date = 26 December 2024 }}</ref> | legal_UN =  | legal_UN_comment = | legal_status =

| CAS_number_Ref = {{cascite|correct|??}} | CAS_number = 71125-38-7 | PubChem = 5281106 | IUPHAR_ligand = 7220 | DrugBank_Ref = {{drugbankcite|correct|drugbank}} | DrugBank = DB00814 | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} | ChemSpiderID = 10442740 | UNII_Ref = {{fdacite|correct|FDA}} | UNII = VG2QF83CGL | KEGG_Ref = {{keggcite|correct|kegg}} | KEGG = D00969 | ChEBI_Ref = {{ebicite|correct|EBI}} | ChEBI = 6741 | ChEMBL_Ref = {{ebicite|correct|EBI}} | ChEMBL = 599 | NIAID_ChemDB = | PDB_ligand = MXM | synonyms =

| IUPAC_name = 4-Hydroxy-2-methyl-''N''-(5-methyl-2-thiazolyl)-2''H''-1,2-benzothiazine-3-carboxamide-1,1-dioxide | C = 14 | H = 13 | N = 3 | O = 4 | S = 2 | SMILES = Cc1cnc(s1)NC(=O)C\3=C(/O)c2ccccc2S(=O)(=O)N/3C | StdInChI_Ref = {{stdinchicite|correct|chemspider}} | StdInChI = 1S/C14H13N3O4S2/c1-8-7-15-14(22-8)16-13(19)11-12(18)9-5-3-4-6-10(9)23(20,21)17(11)2/h3-7,18H,1-2H3,(H,15,16,19) | StdInChI_comment = | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} | StdInChIKey = ZRVUJXDFFKFLMG-UHFFFAOYSA-N | density = | density_notes = | melting_point = | melting_high = | melting_notes = | boiling_point = | boiling_notes = | solubility = | sol_units = | specific_rotation = }}

'''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.<ref name=BNF76>{{cite book | title = British national formulary: BNF 76 | pages = 1112–1113 | date = 2018 | publisher = Pharmaceutical Press | isbn = 978-0-85711-338-2 | edition = 76 }}</ref><ref name="AHFS2018" /> It is taken by mouth or given by injection into a vein.<ref name=AHFS2018>{{cite web | title = Meloxicam Monograph for Professionals | date = 10 June 2025 | url = https://www.drugs.com/monograph/meloxicam.html | website = Drugs.com | publisher = AHFS | access-date = 18 October 2025 }}</ref><ref name="Anjeso PR" /> It is recommended that it be used for as short a period as possible and at a low dose.<ref name="AHFS2018" />

Common side effects include abdominal pain, dizziness, swelling, headache, and a rash.<ref name="AHFS2018" /> Serious side effects may include heart disease, stroke, kidney problems, and stomach ulcers.<ref name="AHFS2018" /> Use is not recommended in the third trimester of pregnancy.<ref name="AHFS2018" /> It blocks cyclooxygenase-2 (COX-2) more than it blocks cyclooxygenase-1 (COX-1).<ref name="AHFS2018" /> It is in the oxicam family of chemicals and is closely related to piroxicam.<ref name="AHFS2018" />

It is available as a generic medication.<ref name="AHFS2018" /> In 2023, it was the 27th most commonly prescribed medication in the United States, with more than 20{{nbsp}}million prescriptions.<ref name="Top300Drugs">{{cite web | title = Top 300 of 2023 | url = https://clincalc.com/DrugStats/Top300Drugs.aspx | website = ClinCalc | access-date = 12 August 2025 | archive-date = 12 August 2025 | archive-url = https://web.archive.org/web/20250812130026/https://clincalc.com/DrugStats/Top300Drugs.aspx | url-status = live }}</ref><ref>{{cite web | title = Meloxicam Drug Usage Statistics, United States, 2014 - 2023 | website = ClinCalc | url = https://clincalc.com/DrugStats/Drugs/Meloxicam | access-date = 13 August 2025 }}</ref> An intravenous version of meloxicam (Anjeso) was approved for medical use in the United States in February 2020.<ref>{{cite web | title = Anjeso- meloxicam injection | date = 22 February 2022 | work = DailyMed | publisher = U.S. National Library of Medicine| url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6f517ef8-9478-494e-adfd-4944b9900df4 | access-date = 8 October 2022 }}</ref><ref name="Anjeso PR" /> Meloxicam is available in combination with bupivacaine as bupivacaine/meloxicam and in combination with rizatriptan as meloxicam/rizatriptan.

== Medical uses == Meloxicam is indicated for the treatment of osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis.<ref name="Mobic FDA label" />

== Adverse effects == {{See also|Nonsteroidal anti-inflammatory drug}}

Meloxicam use can result in gastrointestinal toxicity and bleeding, headaches, rash, and very dark or black stool (a sign of intestinal bleeding). It has fewer gastrointestinal side effects than diclofenac,<ref name="Hawkey_1998" /> piroxicam,<ref>{{cite journal | vauthors = Dequeker J, Hawkey C, Kahan A, Steinbrück K, Alegre C, Baumelou E, Bégaud B, Isomäki H, Littlejohn G, Mau J, Papazoglou S | title = Improvement in gastrointestinal tolerability of the selective cyclooxygenase (COX)-2 inhibitor, meloxicam, compared with piroxicam: results of the Safety and Efficacy Large-scale Evaluation of COX-inhibiting Therapies (SELECT) trial in osteoarthritis | journal = British Journal of Rheumatology | volume = 37 | issue = 9 | pages = 946–951 | date = September 1998 | pmid = 9783758 | doi = 10.1093/rheumatology/37.9.946 | title-link = doi | doi-access = free }}</ref> naproxen,<ref>{{cite journal | vauthors = Wojtulewski JA, Schattenkirchner M, Barceló P, Le Loët X, Bevis PJ, Bluhmki E, Distel M | title = A six-month double-blind trial to compare the efficacy and safety of meloxicam 7.5 mg daily and naproxen 750 mg daily in patients with rheumatoid arthritis | journal = British Journal of Rheumatology | volume = 35 Suppl 1 | issue = Suppl 1 | pages = 22–28 | date = April 1996 | pmid = 8630632 | doi = 10.1093/rheumatology/35.suppl_1.22 | title-link = doi | doi-access = free }}</ref> and perhaps all other NSAIDs which are not COX-2 selective.<ref name="Hawkey_1998">{{cite journal | vauthors = Hawkey C, Kahan A, Steinbrück K, Alegre C, Baumelou E, Bégaud B, Dequeker J, Isomäki H, Littlejohn G, Mau J, Papazoglou S | title = Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients. International MELISSA Study Group. Meloxicam Large-scale International Study Safety Assessment | journal = British Journal of Rheumatology | volume = 37 | issue = 9 | pages = 937–945 | date = September 1998 | pmid = 9783757 | doi = 10.1093/rheumatology/37.9.937 | title-link = doi | doi-access = free }}</ref>

In October 2020, the US Food and Drug Administration (FDA) required the prescribing information to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid.<ref name="FDA PR 20201015" /><ref name="FDA safety 20201015" /> They recommend avoiding NSAIDs in pregnant women at 20 weeks or later in pregnancy.<ref name="FDA PR 20201015">{{cite press release | title = FDA Warns that Using a Type of Pain and Fever Medication in Second Half of Pregnancy Could Lead to Complications | date = 15 October 2020 | website = U.S. Food and Drug Administration (FDA) | url = https://www.fda.gov/news-events/press-announcements/fda-warns-using-type-pain-and-fever-medication-second-half-pregnancy-could-lead-complications | archive-url = https://web.archive.org/web/20201016180003/https://www.fda.gov/news-events/press-announcements/fda-warns-using-type-pain-and-fever-medication-second-half-pregnancy-could-lead-complications | url-status = dead | archive-date = 16 October 2020 | access-date = 15 October 2020 }} {{PD-notice}}</ref><ref name="FDA safety 20201015">{{cite web | title = NSAIDs may cause rare kidney problems in unborn babies | date = 21 July 2017 | website = U.S. Food and Drug Administration (FDA) | url = https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic | archive-url = https://web.archive.org/web/20201017014419/https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic | url-status = dead | archive-date = 17 October 2020 | access-date = 15 October 2020 }} {{PD-notice}}</ref>

=== Cardiovascular === Like other NSAIDs, its use is associated with an increased risk of cardiovascular events such as heart attack and stroke.<ref>{{cite journal | vauthors =Bally M, Dendukuri N, Rich B, Nadeau L, Helin-Salmivaara A, Garbe E, Brophy JM |title=Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data |journal=BMJ |date=May 2017 |volume=357 |article-number=j1909 |doi=10.1136/bmj.j1909 |pmid=28487435 |pmc=5423546 |doi-access=free}}</ref> Although meloxicam inhibits formation of thromboxane A, it does not appear to do so at levels that would interfere with platelet function.<ref name="Zeidan_2013">{{cite journal | vauthors = Zeidan AZ, Al Sayed B, Bargaoui N, Djebbar M, Djennane M, Donald R, El Deeb K, Joudeh RA, Nabhan A, Schug SA | title = A review of the efficacy, safety, and cost-effectiveness of COX-2 inhibitors for Africa and the Middle East region | journal = Pain Practice | volume = 13 | issue = 4 | pages = 316–331 | date = April 2013 | pmid = 22931375 | doi = 10.1111/j.1533-2500.2012.00591.x | s2cid = 205715393 }}</ref><ref name="Gates_2005" /> 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.<ref name="Singh_2004">{{cite journal | vauthors = Singh G, Lanes S, Triadafilopoulos G | title = Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam | journal = The American Journal of Medicine | volume = 117 | issue = 2 | pages = 100–106 | date = July 2004 | pmid = 15234645 | doi = 10.1016/j.amjmed.2004.03.012 }}</ref>

People with hypertension, high cholesterol, or diabetes are at risk for cardiovascular side effects. People with family history of heart disease, heart attack, or stroke should tell their treating physician as the potential for serious cardiovascular side effects is significant.<ref name="AHFS2018" /><ref>{{cite web | title = Meloxicam | url = https://www.medlineplus.gov/druginfo/meds/a601242.html | publisher = MedlinePlus | access-date = 15 November 2014 | archive-date = 29 November 2014 | archive-url = https://web.archive.org/web/20141129020509/http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601242.html | url-status = live }}</ref>

=== Gastrointestinal === NSAIDs cause an increase in the risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients are at greater risk for serious gastrointestinal events.<ref name="AHFS2018" />

== Mechanism of action == {{Main|Non-steroidal anti-inflammatory drug}} 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 low therapeutic doses, to selectively inhibit COX-2 over COX-1.<ref name=drugs1996>{{cite journal | vauthors = Noble S, Balfour JA | title = Meloxicam | journal = Drugs | volume = 51 | issue = 3 | pages = 424–30; discussion 431–32 | date = March 1996 | pmid = 8882380 | doi = 10.2165/00003495-199651030-00007 | s2cid = 260452199 }}</ref>

X-ray crystallographic analyses and molecular modelling studies of meloxicam´s binding to cyclooxygenase isoforms showed that the methyl group of the thiazole ring in meloxicam exploits the "flexible extra space" at the top of the COX-2 channel. The substitution of the second shell amino acid residue Ile434 in COX-1 by Val in COX-2 allows the side chain of Phe518 (a residue at the active side) to open „extra space“, which favors the binding of meloxicam to COX-2. Site-directed mutagenesis studies in which Ile434 was substituted for Val434 in COX-2 confirmed this hypothesis.<ref>{{cite journal | vauthors = Xu S, Hermanson DJ, Banerjee S, Ghebreselasie K, Clayton GM, Garavito RM, Marnett LJ | title = Oxicams bind in a novel mode to the cyclooxygenase active site via a two-water-mediated H-bonding Network | journal = The Journal of Biological Chemistry | volume = 289 | issue = 10 | pages = 6799–6808 | date = March 2014 | pmid = 24425867 | pmc = 3945341 | doi = 10.1074/jbc.M113.517987 | doi-access = free }}</ref> Other oxicams also occupy this binding site, albeit nonselectively because of the missing methyl group in the side chain.<ref>{{cite journal | vauthors = Xu S, Rouzer CA, Marnett LJ | title = Oxicams, a class of nonsteroidal anti-inflammatory drugs and beyond | journal = IUBMB Life | volume = 66 | issue = 12 | pages = 803–811 | date = December 2014 | pmid = 25537198 | pmc = 5300000 | doi = 10.1002/iub.1334 }}</ref>

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 compared to plasma. The significance of this penetration is unknown,<ref name="AHFS2018" /> but it may account for the fact that it performs exceptionally well in treatment of arthritis in animal models.<ref>{{cite journal | vauthors = Engelhardt G, Homma D, Schlegel K, Utzmann R, Schnitzler C | title = Anti-inflammatory, analgesic, antipyretic and related properties of meloxicam, a new non-steroidal anti-inflammatory agent with favourable gastrointestinal tolerance | journal = Inflammation Research | volume = 44 | issue = 10 | pages = 423–433 | date = October 1995 | pmid = 8564518 | doi = 10.1007/BF01757699 | s2cid = 37937305 }}</ref>

== Pharmacokinetics ==

=== Absorption === The bioavailability of meloxicam is decreased when administered orally compared to an equivalent IV bolus dose. Different oral formulations of meloxicam are not bioequivalent.<ref name="AHFS2018" /> Use of oral meloxicam following a high-fat breakfast increases the mean peak drug levels by about 22%; however, the manufacturer does not make any specific meal recommendations. In addition, the use of antacids does not show pharmacokinetic interactions.<ref name="Mobic FDA label" /> With chronic dosing, the time to maximum plasma concentration following oral administration is approximately 5–6 hours.<ref name="Bekker 2018" />

=== Distribution === The mean volume of distribution of meloxicam is approximately 10 L. It is highly protein-bound, mainly to albumin.<ref name="Gates_2005">{{cite journal | vauthors = Gates BJ, Nguyen TT, Setter SM, Davies NM | title = Meloxicam: a reappraisal of pharmacokinetics, efficacy and safety | journal = Expert Opinion on Pharmacotherapy | volume = 6 | issue = 12 | pages = 2117–2140 | date = October 2005 | pmid = 16197363 | doi = 10.1517/14656566.6.12.2117 | quote = Meloxicam is extensively bound to plasma proteins (99.4%), primarily to albumin. Meloxicam has an apparent volume of distribution (Vd) 10 – 15 L in humans (0.1 – 0.2 L/kg) after oral administration and a mean volume of distribution at steady-state of 0.2 L/kg after intravenous administration." "None of the meloxicam treatment groups demonstrated inhibition of platelet aggregation to either arachidonic acid (AC) or adenosine diphosphate (ADP). However, there were no significant changes in the platelet count, prothrombin, and activated partial thromboplastin time in any of the meloxicam and indomethacin groups. Other crossover studies also confirmed that meloxicam 15 mg/day caused a major reduction of maximum thromboxane production, but no reduction in collagen- or AC-induced platelet aggregation. | s2cid = 25512189 }}</ref><ref name="Bekker 2018">{{cite journal | vauthors = Bekker A, Kloepping C, Collingwood S | title = Meloxicam in the management of post-operative pain: Narrative review | journal = Journal of Anaesthesiology Clinical Pharmacology | volume = 34 | issue = 4 | pages = 450–457 | date = 2018 | pmid = 30774225 | pmc = 6360894 | doi = 10.4103/joacp.JOACP_133_18 | title-link = doi | doi-access = free }}</ref>

=== Metabolism === Meloxicam is extensively metabolized in the liver by the enzymes CYP2C9 and CYP3A4 (minor) into four inactive metabolites. Peroxidase activity is thought to be responsible for the other two remaining metabolites.<ref name="AHFS2018" /><ref name="Mobic FDA label" />

=== Excretion === Meloxicam is predominantly excreted in the form of metabolites and occurs to equal extents in the urine and feces.<ref name="Mobic FDA label" /> Traces of unchanged parent drug are found in urine and feces.<ref name="Mobic FDA label" /> The mean elimination half-life ranges from 15 to 20 hours.<ref name="Mobic FDA label" />

Adverse events are dose-dependent and associated with length of treatment.<ref name="Mobic FDA label" /><ref name=":0">{{cite journal | author1 = By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel | title = American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults | journal = Journal of the American Geriatrics Society | volume = 67 | issue = 4 | pages = 674–694 | date = April 2019 | pmid = 30693946 | doi = 10.1111/jgs.15767 | s2cid = 59338182 }}</ref>

==Research and development== In the 1970s, chemists at Dr. Karl Thomas GmbH, a subsidiary of Boehringer-Ingelheim in Germany, synthesized a variety of enol carboxamides with the aim of obtaining active ingredients with anti-inflammatory or antithrombotic properties.<ref>{{cite journal | vauthors = Lazer ES, Miao CK, Cywin CL, Sorcek R, Wong HC, Meng Z, Potocki I, Hoermann M, Snow RJ, Tschantz MA, Kelly TA, McNeil DW, Coutts SJ, Churchill L, Graham AG, David E, Grob PM, Engel W, Meier H, Trummlitz G | title = Effect of structural modification of enol-carboxamide-type nonsteroidal antiinflammatory drugs on COX-2/COX-1 selectivity | journal = Journal of Medicinal Chemistry | volume = 40 | issue = 6 | pages = 980–989 | date = March 1997 | pmid = 9083488 | doi = 10.1021/jm9607010 }}</ref> A compound belonging to the oxicams (UH-AC 62, meloxicam) stood out, exhibiting antiinflammatory activity in the pharmacological adjuvant arthritis model, but only low antithrombotic efficacy as measured by platelet aggregation.<ref name="Gates_2005" /> Dr. Karl Thomas GmbH filed the German basic patent DE2756113 (1979) and Boehringer Ingelheim US patent 4,233,299 (1980) and patents in many other countries.<ref>{{Cite web | title = Meloxicam | date = 27 September 2025 | url = https://pubchem.ncbi.nlm.nih.gov/compound/54677470 | access-date = 17 October 2025 | publisher = PubChem, US National Library of Medicine }}</ref>

== Veterinary use == Meloxicam is used in veterinary medicine mainly to treat dogs,<ref name="Metacam oral FDA label">{{cite web | title = Metacam- meloxicam suspension | work = DailyMed | publisher = U.S. National Library of Medicine| url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed2227e6-8c69-4057-a8b2-94f74cb11264 | access-date = 15 May 2021 }}</ref><ref name="Metacam injection FDA label">{{cite web | title = Metacam- meloxicam injection, solution | work = DailyMed | publisher = U.S. National Library of Medicine| url = https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ca78caf5-2b47-46c1-abec-0f925b39f455 | access-date = 15 May 2021 }}</ref> but also sees off-label use in other animals such as cattle and exotics.<ref>Off-label use discussed in: Arnold Plotnick MS, DVM, ACVIM, ABVP, [http://www.manhattancats.com/Articles/pain.html Pain Management using Metacam] {{webarchive|url=https://web.archive.org/web/20110714025604/http://www.manhattancats.com/Articles/pain.html |date=14 July 2011 }}, and Stein, Robert, [http://www.vasg.org/perioperative_pain_management_part_iv.htm Perioperative Pain Management] {{Webarchive|url=https://web.archive.org/web/20100418035553/http://www.vasg.org/perioperative_pain_management_part_iv.htm |date=18 April 2010 }} Part IV, Looking Beyond Butorphanol, Sep 2006, Veterinary Anesthesia & Analgesia Support Group.</ref><ref>For off-label use example in rabbits, see Krempels, Dana, [http://www.bio.miami.edu/hare/paresis.html Hind Limb Paresis and Paralysis in Rabbits] {{Webarchive|url=https://web.archive.org/web/20100617192652/http://www.bio.miami.edu/hare/paresis.html |date=17 June 2010 }}, University of Miami Biology Department.</ref> In the European Union and other countries it is not considered off-label and can be used in cattle, pigs, horses, dogs, cats and guinea pigs.<ref>{{Cite web | title = Metacam | date = 31 July 2006 | url = https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam | access-date = 17 November 2024 | website = European Medicines Agency (EMA) }}</ref> It has also been investigated as an alternative to diclofenac by the Royal Society for the Protection of Birds (RSPB) to prevent deaths of vultures.<ref name="Swan Naidoo Cuthbert">{{cite journal | vauthors = Swan G, Naidoo V, Cuthbert R, Green RE, Pain DJ, Swarup D, Prakash V, Taggart M, Bekker L, Das D, Diekmann J, Diekmann M, Killian E, Meharg A, Patra RC, Saini M, Wolter K | title = Removing the threat of diclofenac to critically endangered Asian vultures | journal = PLOS Biology | volume = 4 | issue = 3 | pages = e66 | date = March 2006 | pmid = 16435886 | pmc = 1351921 | doi = 10.1371/journal.pbio.0040066 | title-link = doi | doi-access = free }}</ref>

Depending on the animal species, each country or union of countries applies different guidelines or legal frameworks for the use of the drug, as well as different recorded side effects. The most common side effects in dogs include gastrointestinal irritation (vomiting, diarrhea, and ulceration).<ref name="Metacam oral FDA label" /> As far as the perioperative administration is concerned, in healthy dogs given meloxicam, no perioperative adverse effects on the cardiovascular system have been reported at recommended dosages.<ref>{{cite journal | vauthors = Boström IM, Nyman G, Hoppe A, Lord P | title = Effects of meloxicam on renal function in dogs with hypotension during anaesthesia | journal = Veterinary Anaesthesia and Analgesia | volume = 33 | issue = 1 | pages = 62–69 | date = January 2006 | pmid = 16412133 | doi = 10.1111/j.1467-2995.2005.00208.x }}</ref> Perioperative administration of meloxicam to cats did not affect postoperative respiratory rate nor heart rate.<ref>{{cite journal | vauthors = Höglund OV, Dyall B, Gräsman V, Edner A, Olsson U, Höglund K | title = Effect of non-steroidal anti-inflammatory drugs on postoperative respiratory and heart rate in cats subjected to ovariohysterectomy | journal = Journal of Feline Medicine and Surgery | volume = 20 | issue = 10 | pages = 980–984 | date = October 2018 | pmid = 29165006 | pmc = 11129237 | doi = 10.1177/1098612X17742290 | s2cid = 30649716 }}</ref>

=== Use of meloxicam in cats === The issue of using meloxicam in cats involves conflicting guidelines, differing legislation, and a narrow therapeutic safety margin that can easily turn the drug from cure to poison. More specifically:

==== US policy vs EU policy ==== The US Food and Drug Administration (FDA) approves the use of meloxicam in cats only in injectable form and only as a one-time injection given before surgery.<ref>{{Cite web | title = Get the Facts about Pain Relievers for Pets | date = 29 September 2022 | url = https://www.fda.gov/animal-veterinary/animal-health-literacy/get-facts-about-pain-relievers-pets | archive-url = https://web.archive.org/web/20190912042032/https://www.fda.gov/animal-veterinary/animal-health-literacy/get-facts-about-pain-relievers-pets | url-status = dead | archive-date = 12 September 2019 | website = U.S. Food and Drug Administration (FDA) }}</ref><ref>{{Cite web | title = What Veterinarians Should Advise Clients About Pain Control and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Dogs and Cats | date = 15 August 2023 | url = https://www.fda.gov/animal-veterinary/resources-you/what-veterinarians-should-advise-clients-about-pain-control-and-nonsteroidal-anti-inflammatory-drugs | archive-url = https://web.archive.org/web/20220803051610/https://www.fda.gov/animal-veterinary/resources-you/what-veterinarians-should-advise-clients-about-pain-control-and-nonsteroidal-anti-inflammatory-drugs | url-status = dead | archive-date = 3 August 2022 | website = U.S. Food and Drug Administration (FDA) }}</ref> It does not approve meloxicam oral suspension for cats and it does not approve meloxicam spray for cats because after reviewing numerous reports of meloxicam side effects in cats, it has identified many cases of acute renal failure and death and has added the following boxed warning to the prescription label: "Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. See Contraindications, Warnings, and Precautions for detailed information."<ref>{{Cite web | title = Information about the Boxed Warning on Meloxicam Labels regarding Safety Risks in Cats | date = 14 August 2023 | url = https://www.fda.gov/animal-veterinary/product-safety-information/information-about-boxed-warning-meloxicam-labels-regarding-safety-risks-cats | archive-url = https://web.archive.org/web/20220803051610/https://www.fda.gov/animal-veterinary/product-safety-information/information-about-boxed-warning-meloxicam-labels-regarding-safety-risks-cats | url-status = dead | archive-date = 3 August 2022 | website = U.S. Food and Drug Administration (FDA) }}</ref>

In contrast, in the European Union and other continents or countries, the use of the drug in cats is allowed with no such warning.<ref>{{Cite web | title = Metacam | date = 31 July 2006 | url = https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam | access-date = 29 March 2024 | website = European Medicines Agency (EMA) }}</ref><ref>{{Cite news | title = Cats: Meloxicam Question for Department for Environment, Food and Rural Affairs | url = https://questions-statements.parliament.uk/written-questions/detail/2021-05-11/HL10/ | work = UK Parliament Written questions, answers and statements }}</ref> The product instruction leaflet for meloxicam for cats in the form of oral suspension 0.5 mg/ml states that: "Typical adverse reactions of NSAIDs such as loss of appetite, vomiting, diarrhoea, faecal occult blood, apathy, and renal failure have occasionally been reported. These side effects are in most cases transient and disappear following termination of the treatment but in very rare cases may be serious or fatal."<ref name="cite39c33e59">{{Cite web | title = Clinical particulars - Meloxidyl 0.5 mg/ml oral suspension for cats | url = https://www.noahcompendium.co.uk/?id=-474521 | access-date = 29 March 2024 | website = www.noahcompendium.co.uk }}</ref>

==== Dosage and safety margin ==== The data sheets for meloxicam products for cats also state that: "Meloxicam has a narrow therapeutic safety margin in cats and clinical signs of overdose may be seen at relatively small overdose levels."<ref name="cite39c33e59" />

==== Additional studies ==== Some additional information about giving meloxicam to cats from researchers is as follows: A peer-reviewed journal article cites NSAIDs, including meloxicam, as causing gastrointestinal upset and, at high doses, acute kidney injury and CNS signs such as seizures and comas in cats. It adds that cats have a low tolerance for NSAIDs.<ref>{{cite journal | title = Toxicology Brief: The 10 most common toxicoses in cats | journal = Dvm360 | date = 1 June 2006 | url = http://veterinarymedicine.dvm360.com/toxicology-brief-10-most-common-toxicoses-cats?id=&sk=&date=&pageID=3 | url-status = live | archive-url = https://web.archive.org/web/20180829212043/http://veterinarymedicine.dvm360.com/toxicology-brief-10-most-common-toxicoses-cats?id=&sk=&date=&pageID=3 | archive-date = 29 August 2018 | access-date = 16 September 2018 }}</ref><ref>{{cite journal | vauthors = Merola V, Dunayer E | title = The 10 most common toxicoses in cats | journal = Veterinary Medicine | pages = 340–342 | date = June 2006 | url = https://www.aspcapro.org/sites/default/files/zl-vetm0606_339-342.pdf | url-status = live | archive-url = https://web.archive.org/web/20190809040133/https://www.aspcapro.org/sites/default/files/zl-vetm0606_339-342.pdf | archive-date = 9 August 2019 | access-date = 9 August 2019 }}</ref> Also, in another scientific journal there is talk of research according to which cats that received meloxicam had greater proteinuria at 6 months than cats that received placebo. It was concluded that meloxicam should be used with caution in cats with chronic kidney disease.<ref>{{cite journal | vauthors = KuKanich K, George C, Roush JK, Sharp S, Farace G, Yerramilli M, Peterson S, Grauer GF | title = Effects of low-dose meloxicam in cats with chronic kidney disease | journal = Journal of Feline Medicine and Surgery | volume = 23 | issue = 2 | pages = 138–148 | date = February 2021 | pmid = 32594827 | pmc = 10741344 | doi = 10.1177/1098612X20935750 | s2cid = 220256059 }}</ref>

=== Pharmacokinetics === In dogs, the absorption of meloxicam from the stomach is not affected by the presence of food,<ref name="Khan 2012">{{cite journal | vauthors = Khan SA, McLean MK | title = Toxicology of frequently encountered nonsteroidal anti-inflammatory drugs in dogs and cats | journal = The Veterinary Clinics of North America. Small Animal Practice | volume = 42 | issue = 2 | pages = 289–306, vi–vii | date = March 2012 | pmid = 22381180 | doi = 10.1016/j.cvsm.2012.01.003 }}</ref> with the peak concentration (Cmax) of meloxicam occurring in the blood 7–8 hours after administration.<ref name="Khan 2012" /> The half-life of meloxicam is approximately 24 hours in dogs.<ref name="Khan 2012"/> In the koala (''Phascolarctos cinereus''), very little meloxicam is absorbed into the blood after oral administration (that is, it has poor bioavailability).<ref>{{cite journal | vauthors = Kimble B, Black LA, Li KM, Valtchev P, Gilchrist S, Gillett A, Higgins DP, Krockenberger MB, Govendir M | title = Pharmacokinetics of meloxicam in koalas (Phascolarctos cinereus) after intravenous, subcutaneous and oral administration | journal = Journal of Veterinary Pharmacology and Therapeutics | volume = 36 | issue = 5 | pages = 486–493 | date = October 2013 | pmid = 23406022 | doi = 10.1111/jvp.12038 | title-link = doi | doi-access = free }}</ref>

=== Legal status === ==== United States ==== 2003: Meloxicam was approved in the US for use in dogs for the management of pain and inflammation associated with osteoarthritis, as an oral (liquid) formulation of meloxicam.<ref>{{cite web | title = NADA 141-213: New Animal Drug Application Approval (for Metacam (meloxicam) 0.5 mg/mL and 1.5 mg/mL Oral Suspension) | date = 15 April 2003 | url = https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118006.pdf | publisher = U.S. Food and Drug Administration (FDA) | access-date = 24 July 2010 | archive-url = https://wayback.archive-it.org/7993/20170406084237/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118006.pdf | archive-date = 6 April 2017 | url-status = dead }}</ref>

2003 (November): An injectable formulation for use in dogs was approved by the US Food and Drug Administration (FDA).<ref>{{cite web | title = NADA 141-219: Metacam (meloxicam) 5 mg/mL Solution for Injection | date = 12 November 2003 | url = https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118026.pdf | url-status = dead | archive-url = https://wayback.archive-it.org/7993/20171115072315/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118026.pdf | archive-date = 15 November 2017 | access-date = 8 August 2019 | publisher = U.S. Food and Drug Administration (FDA) }}</ref>

2004 (October): A formulation for use in cats was approved for use before surgery only.<ref>{{cite web | title = Metacam 5 mg/mL Solution for Injection, Supplemental Approval | date = 28 October 2004 | url = https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118027.pdf | url-status = dead | archive-url = https://wayback.archive-it.org/7993/20171115072316/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118027.pdf | archive-date = 15 November 2017 | access-date = 8 August 2019 | publisher = U.S. Food and Drug Administration (FDA) }}</ref> 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.<ref>See the manufacturer's [http://www.metacam.com/index.php/FAQs-Veterinary-Professionals FAQ] {{Webarchive|url=https://web.archive.org/web/20110702180646/http://www.metacam.com/index.php/FAQs-Veterinary-Professionals|date=2 July 2011}} on its website, and its [http://www.bi-vetmedica.com/product_sites/METACAMINCats/documents/Metacam_Inj_cats_label.pdf clinical dosing instructions for cats.] {{webarchive|url=https://web.archive.org/web/20080906211039/http://www.bi-vetmedica.com/product_sites/METACAMINCats/documents/Metacam_Inj_cats_label.pdf|date=6 September 2008}}</ref>

2005 (January): The product insert added a warning in bold-face type: "Do not use in cats."<ref name="ProdInsert">{{cite web | title = Client Information Sheet For Metacam (meloxicam) 1.5 mg/mL Oral Suspension | date = January 2005 | url = https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/UCM050394.pdf | publisher = U.S. Food and Drug Administration (FDA) | quote = Metacam is a prescription non-steroidal anti-inflammatory drug (NSAID) that is used to control pain and inflammation (soreness) due to osteoarthritis in dogs. Osteoarthritis (OA) is a painful condition caused by “wear and tear” of cartilage and other parts of the joints that may result in the following changes or signs in your dog: Limping or lameness, decreased activity or exercise (reluctance to stand, climb stairs, jump or run, or difficulty in performing these activities), stiffness or decreased movement of joints. Metacam is given to dogs by mouth. Do not use Metacam Oral Suspension in cats. Acute kidney injury and death have been associated with the use of meloxicam in cats. | archive-url = https://wayback.archive-it.org/7993/20171115070141/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/UCM050394.pdf | archive-date = 15 November 2017 | url-status = dead | df = dmy-all }}</ref>

2005: The FDA sent a Notice of Violation to the manufacturer for its promotional materials which included promotion of the drug for off-label use.<ref>{{cite web | title = Notice of Violation | date = 19 April 2005 | url = https://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/ComplianceEnforcement/ucm042460.pdf | publisher = U.S. Food and Drug Administration (FDA) | access-date = 8 August 2019 | archive-url = https://wayback.archive-it.org/7993/20170113141217/https://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/ComplianceEnforcement/ucm042460.pdf | archive-date = 13 January 2017 | url-status = dead | df = dmy-all }}</ref>

2020 (February): A meloxicam injection was approved for use in the United States. Specifically, the FDA granted the approval of Anjeso to Baudax Bio.<ref name="Anjeso PR">{{cite press release | title = Baudax Bio Announces FDA Approval of Anjeso for the Management of Moderate to Severe Pain | date = 20 February 2020 | website = Baudax Bio, Inc. | url = https://www.baudaxbio.com/news-and-investors/press-releases/detail/160/baudax-bio-announces-fda-approval-of-anjeso-for-the | access-date = 20 February 2020 | archive-date = 21 February 2020 | archive-url = https://web.archive.org/web/20200221055028/https://www.baudaxbio.com/news-and-investors/press-releases/detail/160/baudax-bio-announces-fda-approval-of-anjeso-for-the | url-status = live }}</ref><ref>{{cite web | title = Anjeso (meloxicam) injection, for intravenous use | date = February 2020 | url = https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210583s000lbl.pdf | publisher = U.S. Food and Drug Administration (FDA) | access-date = 21 February 2020 | archive-date = 22 February 2020 | archive-url = https://web.archive.org/web/20200222070146/https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210583s000lbl.pdf | url-status = dead }}</ref>

==== European Union ==== In the European Union, meloxicam is licensed for other anti-inflammatory benefits including relief from both acute and chronic pain in dogs. Meloxicam is also licensed for use in horses, to relieve the pain associated with musculoskeletal disorders.<ref>{{cite book | veditors = Maddison JE, Page SW, Church D | chapter = Meloxicam | title = Small animal clinical pharmacology | location = Edinburgh | pages = [https://archive.org/details/smallanimalclini00mrcv/page/n305 301]–302 | date = 2008 | url = https://archive.org/details/smallanimalclini00mrcv | url-access = limited | publisher = Saunders/Elsevier | isbn = 978-0-7020-2858-8 | edition = 2nd }}</ref>

1998 (January): Meloxicam was authorised for use in cattle throughout the European Union, via a centralised marketing authorisation.<ref name="Wright 2007">{{cite journal | vauthors = Wright E | title = Generic and biosimilar medicinal products in the European Union | journal = Chemistry Today | volume = 25 | issue = 2 | pages = 4–6 | date = March 2007 | url = https://www.hoganlovells.com/~/media/hogan-lovells/pdf/publication/chemistrytodayapr07_pdf.pdf | access-date = 28 January 2020 | archive-date = 28 January 2020 | archive-url = https://web.archive.org/web/20200128032019/https://www.hoganlovells.com/~/media/hogan-lovells/pdf/publication/chemistrytodayapr07_pdf.pdf | url-status = live }}</ref>

2006: The first generic meloxicam product was approved.<ref name="Wright 2007" />

2024 (January): EMA issued an 'Opinion'<ref>{{Cite web | title = Meeting highlights from the Committee for Veterinary Medicinal Products (CVMP) 16-17 January 2024 {{!}} European Medicines Agency (EMA)|date=19 January 2024|url=https://www.ema.europa.eu/en/news/meeting-highlights-committee-veterinary-medicinal-products-cvmp-16-17-january-2024|access-date=25 January 2025|website=www.ema.europa.eu|language=en}}</ref> on a change to this medicine's authorisation concerning the follow-up oral treatment after initial injectable administration in cats. This change remains as an 'Opinion', while the medication continues to be approved as usual.<ref>{{Cite web | title = Metacam | date = 31 July 2006 | url = https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam | access-date = 16 November 2024 | website = European Medicines Agency (EMA) }}</ref>

==== Other countries ==== {{As of|June 2008}}, meloxicam was registered for long-term use in cats in Australia, New Zealand, and Canada.<ref name="Gashen 2016">{{cite book | veditors = Gaschen FP, Schaer M | chapter = Recent NSAID developments | title = Clinical medicine of the dog and cat | pages = <!––no page numbers in ebook––> | date = 2016 | publisher = CRC Press | isbn = 978-1-4822-2606-5 | edition = 3rd | chapter-url = https://books.google.com/books?id=fjqLDQAAQBAJ&dq=meloxicam+cat+australia&pg=PT2004 | access-date = 28 January 2020 | archive-date = 1 September 2020 | archive-url = https://web.archive.org/web/20200901204800/https://www.google.com/books/edition/Clinical_Medicine_of_the_Dog_and_Cat/fjqLDQAAQBAJ?hl=en&gbpv=1&dq=meloxicam+cat+australia&pg=PT2004 | url-status = live }}</ref>

In the United Kingdom, meloxicam is licensed for use in cats, guinea pigs, horses, and livestock including pigs and cattle.<ref>{{cite web | title = Product Information Database | url = https://www.vmd.defra.gov.uk/ProductInformationDatabase/current?page=79&order=ActiveSubstances&descending=True | website = Veterinary Medicines Directorate | publisher = DEFRA | access-date = 29 March 2023 }}</ref>

== See also == * Bupivacaine/meloxicam

== References == {{Reflist}} {{Commons}} {{Anti-inflammatory products}} {{Portal bar | Medicine}} {{Authority control}}

Category:Benzothiazines Category:Drugs developed by Boehringer Ingelheim Category:Carboxamides Category:Cat medications Category:Dog medications Category:Medicine in the United States Navy Category:Nonsteroidal anti-inflammatory drugs Category:Wikipedia medicine articles ready to translate Category:Thiazoles Category:Veterinary drugs Category:Sultams