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Meloxicam Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

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)

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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.

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