Meloxicam

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Meloxicam

Clinical data

Trade names Mobic, Metacam

AHFS/Drugs.com Monograph

MedlinePlus a601242

Pregnancy  AU: C

category  US: C (Risk not ruled out)

Routes of Oral
administration

ATC code  M01AC06 (WHO)

Legal status

Legal status  AU: S4 (Prescription only)

  UK: POM (Prescription only)

 US: ℞-only

Pharmacokinetic data

Bioavailability 89%[1]

Protein binding 99.4%[1]

Metabolism Hepatic (CYP2C9 and 3A4-mediated)[1]

Elimination half-life 20 hours[1]

Excretion Urine and faeces equally[1]

Identifiers

IUPAC name[show]

CAS Number  71125-38-7

PubChem CID  5281106

IUPHAR/BPS  7220

DrugBank  DB00814

ChemSpider  10442740

UNII  VG2QF83CGL

KEGG  D00969

ChEBI  CHEBI:6741 ‹See TfM›

ChEMBL  ChEMBL599

PDB ligand  MXM (PDBe, RCSB PDB)

ECHA InfoCard 100.113.257

Chemical and physical data

Formula C14H13N3O4S2

Molar mass 351.403 g/mol

3D model (JSmol)  Interactive image

SMILES[show]

InChI[show]

‹See TfM›
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Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) with analgesic and anti-

pyretic effects. It is an oxicam closely related to piroxicam, and falls in the enolic acid group of
NSAIDs.[2] It was developed by Boehringer-Ingelheim. Meloxicam starts to relieve pain about 30–
60 minutes after administration.[3]
 As of 2015 the cost for a typical month of medication in the United States is less than $25 USD.[4]

Contents

 1Adverse effects
o 1.1Cardiovascular side effects
 2Mechanism of action
 3Veterinary use
o 3.1Pharmacokinetics
o 3.2Legal status
 3.2.1United States
 3.2.2European Union
 3.2.3Other countries
 4References
 5External links

Adverse effects[edit]
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). Like other NSAIDs, its use is associated with an
increased risk of cardiovascular events such as heart attack and stroke.[5] It has fewer
gastrointestinal side effects than diclofenac,[6] piroxicam,[7] naproxen,[8] and perhaps all other
NSAIDs which are not COX-2 selective.[6] Although meloxicam inhibits formation
of thromboxane A, it does not appear to do so at levels that would interfere with platelet function.
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.[9]
Cardiovascular side effects[edit]
Persons with hypertension, high cholesterol, or diabetes are at risk for cardiovascular side
effects. Persons with family history of heart disease, heart attack, or stroke must tell their treating
physician as the potential for serious cardiovascular side effects is significant.[10][11]

Mechanism of action[edit]
Main article: 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 its low therapeutic doses, selectively
to inhibit COX-2 over COX-1.[1]
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 as compared to plasma. The significance of this penetration is unknown,[2] but it
may account for the fact that it performs exceptionally well in treatment of arthritis in animal
models.[12]

Veterinary use[edit]
Meloxicam is used in veterinary medicine, most commonly in dogs and cats, but also sees off-
label use in other animals such as cattle and exotics.[13][14]
Side effects in animals are similar to those found in humans; the principal side effect is
gastrointestinal irritation (vomiting, diarrhea, and ulceration). Rarer but important side effects
include liver and kidney toxicity.
In healthy dogs given meloxicam, no perioperative adverse effects on the cardiovascular system
have been reported at recommended dosages.[15] Perioperative administration of meloxicam to
cats did not affect postoperative respiratory rate nor heart rate.[16]
A peer-reviewed journal article cites NSAIDs, including meloxicam, as causing gastrointestinal
upset and, at high doses, acute renal failure and CNS signs such as seizures and comas in cats.
It adds that cats have a low tolerance for NSAIDs.[17][18]
Meloxicam has been investigated as an alternative to diclofenac by the RSPB to prevent deaths
of vultures.[citation needed]
Pharmacokinetics[edit]
In dogs, the absorption of meloxicam from the stomach is not affected by the presence of
food,[19] with the peak concentration (Cmax) of meloxicam occurring in the blood 7–8 hours after
administration.[19] The half-life of meloxicam is approximately 24 hours in dogs.[19]
In the koala (Phascolarctos cinereus), very little meloxicam is absorbed into the blood after oral
administration (that is, it has poor bioavailability).[20]