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# 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

- Class: [Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)
- Enzyme: Cyclooxygenase 2 (COX-2), also acting on COX-1
- ATC code: M01AC06

✂**Cyclooxygenase 2 (COX-2), also acting on COX-1**Meloxicam

ⓘ 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](https://www.rcsb.org/structure/4M11) · Drag to rotate · pinch to zoom

## 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.

- Binds the active site of COX-2 (and, less, COX-1)
- Lowers prostaglandin synthesis in the inflamed joint
- Less pain and inflammation
- 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

- Osteoarthritis [Knee Osteoarthritis →](https://durgical.com/en/conditions/knee-osteoarthritis/)
- Rheumatoid arthritis [Rheumatoid arthritis →](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- Juvenile idiopathic arthritis in patients of sufficient weight

## Adverse effects

### Common

- Diarrhoea, constipation and gas
- Sore throat

### Serious (rare, important)

- Cardiovascular thrombotic events (heart attack, stroke)
- Gastrointestinal ulcer, bleeding and perforation
- Acute kidney injury and hyperkalaemia
- Hepatotoxicity
- Anaphylaxis and serious skin reactions

## 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.

## Memory aid

MELOXIcam = «MELLOW, once a day»: a long-acting oxicam that favours COX-2 without being a coxib.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/meloxicam/)

## Related drugs

- [Piroxicam](https://durgical.com/en/pharmacology/piroxicam/)
- [Celecoxib](https://durgical.com/en/pharmacology/celecoxib/)
- [Diclofenac](https://durgical.com/en/pharmacology/diclofenac/)

## Related conditions

- [Knee Osteoarthritis](https://durgical.com/en/conditions/knee-osteoarthritis/)
- [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/)

[← Back to the class: Nonsteroidal anti-inflammatory drugs (NSAIDs)](https://durgical.com/en/pharmacology/classes/nonsteroidal-anti-inflammatory-drugs/)

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](https://medlineplus.gov/druginfo/meds/a601242.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [MELOXICAM tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=20871c7f-1e36-49ef-8e2b-70112430ca1e) (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](https://atcddd.fhi.no/atc_ddd_index/?code=M01AC06) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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