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Pharmacology · Nonsteroidal anti-inflammatory drugs (NSAIDs)

Meloxicam !

An oxicam NSAID that favours COX-2 at usual doses and is given once a day. It is used in osteoarthritis and rheumatoid arthritis.

Updated 2026-11-01

The figure shows meloxicam in the active site of mouse COX-2, which keeps the same site as the human enzyme.

Target in 3D: Cyclooxygenase 2 (COX-2), also acting on COX-1. PDB structure 4M11 (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Meloxicam, an oxicam, inhibits the cyclooxygenases with some preference for COX-2 at therapeutic doses, without being a coxib. It lowers the prostaglandins that drive inflammation and pain. Like other NSAIDs, it keeps the gastrointestinal, renal and cardiovascular risks, which grow with the dose.

  1. Binds the active site of COX-2 (and, less, COX-1)
  2. Lowers prostaglandin synthesis in the inflamed joint
  3. Less pain and inflammation
  4. Long effect: one dose a day is enough

Pharmacokinetics

Absorption
Good oral bioavailability.
Distribution
Highly protein bound, so dialysis removes it poorly in overdose.
Metabolism
Liver, mainly by CYP2C9, with a minor CYP3A4 contribution.
Elimination
As metabolites, in urine and faeces in similar amounts.

Indications

Adverse effects

Common

  • Diarrhoea, constipation and gas
  • Sore throat

Contraindications

  • Hypersensitivity to meloxicam
  • Asthma, urticaria or another allergic reaction after acetylsalicylic acid or another NSAID
  • The setting of coronary artery bypass graft (CABG) surgery

Key interactions

Cholestyramine
Speeds the elimination of meloxicam.
Anticoagulants, antiplatelet agents, SSRIs and SNRIs
Add to the risk of bleeding.
ACE inhibitors, ARBs and diuretics
Weaker blood pressure effect and risk of acute kidney injury in older or volume-depleted patients.
Lithium and methotrexate
Raise their levels and toxicity.

What is monitored

  • Signs of gastrointestinal bleeding
  • Kidney function, potassium and blood pressure
  • Liver enzymes in long-term use

Administration and safety

  • Different oral meloxicam formulations are not interchangeable even when the milligram amount is the same.
  • Check that the patient is not receiving another NSAID at the same time.

Nursing care

  • Ask about a history of ulcer, bleeding, kidney or cardiovascular disease.
  • Watch for black stools, abdominal pain and signs of anaemia.
  • Watch blood pressure, oedema and urine output.

Pregnancy and breastfeeding

Like other NSAIDs, from about week 20 it can cause oligohydramnios through fetal kidney dysfunction, and from about week 30 premature closure of the ductus arteriosus.

Test yourself

Think of the answer, then tap the question to see it.

Which chemical group does meloxicam belong to, and which enzyme does it favour?

It is an oxicam and, at therapeutic doses, preferentially inhibits COX-2, although it is not a coxib.

Which drug speeds the elimination of meloxicam and may help after an overdose?

Cholestyramine.

Why is dialysis not useful in meloxicam overdose?

Because it is highly bound to plasma proteins.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Meloxicam: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); MELOXICAM tablet (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 42 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.