Meloxicam (Mobic, Vivlodex) is a relatively newer painkiller and anti-inflammatory drug. It is commonly used for osteoarthritis and rheumatoid arthritis. It may also cause side effects and interactions that patients should be aware about. Educate yourself about this drug and the natural options that work in a similar way.

Disclaimer: By writing this post, we are not recommending this drug. Some of our readers who were already taking the drug requested that we commission a post on it, and we are simply providing information that is available in the clinical and scientific literature. Please discuss your medications with your doctor.

What is Meloxicam?

Meloxicam is a newer nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are drugs that reduce fever, pain, and inflammation. Most NSAIDs can cause stomach or heart side effects, and sometimes serious health complications. Meloxicam could be a better choice than others, due to a lower risk of stomach side effects [1].

Meloxicam is commonly used to treat chronic inflammatory diseases, such as osteoarthritis, rheumatoid arthritis in adults and children, and low back pain (lumbago) [2].

Mechanism of Action

COX enzymes produce compounds that may cause inflammation in the body (prostaglandins and thromboxane). There are 2 main COX enzymes, with different roles:

  • COX-1 is normally active and protects the stomach, kidneys, and blood vessels. Blocking it can cause damage, especially to the stomach. If it’s overactive in other parts of the body (such as joints), it can cause pain and inflammation [3].
  • COX-2 is more active during inflammation and doesn’t exist in the stomach. It may also protect the heart and have other health functions [3, 4].

Meloxicam blocks both COX enzymes, reducing inflammation, pain, and fever [5, 6].

In lower doses, meloxicam decreases COX-2 more than COX-1 [6, 7].

Meloxicam Uses

1) Reduces Osteoarthritic Pain

Meloxicam (7.5 mg) reduced pain in a study of 336 patients with osteoarthritis (double-blind randomized controlled trial), improving symptoms and quality of life in most. In another study of 229 patients with osteoarthritis (double-blind randomized controlled trial), meloxicam reduced sudden severe pain in the lower spine and caused fewer side effects than diclofenac [8, 9].

Meloxicam (15 mg) reduced moderate to severe pain in a study of 139 patients (open-label) with hip or knee osteoarthritis. In this study, 4 in 10 patients had mild pain or no pain after 12 weeks of daily use, and most tolerated treatment well [10].

Lower-dose meloxicam (SoluMatrix) is formulated with the goal of reducing side effects. In a study (double-blind randomized controlled trial) of 403 patients with osteoarthritis, both the 5 mg and 10 mg meloxicam dose reduced pain and stiffness over 3 months [11].

2) Improves Rheumatoid Arthritis in Adults

Meloxicam is approved by the FDA for treating both rheumatoid arthritis (RA) and osteoarthritis [7].

In a large study of 894 patients with RA (double-blind randomized controlled trial), varying meloxicam doses (7.5 mg, 15 mg, and 22.5 mg) improved rheumatoid arthritis. Meloxicam reduced joint swelling, tenderness, pain, and overall symptoms [12].

In a study of 379 patients (double-blind randomized controlled trial), meloxicam (7.5 mg) reduced joint pain and swelling, similarly to another standard drug (naproxen). Half of the participants received meloxicam over 6 months, with no serious side effects [13].

In 357 patients with RA, meloxicam (15 mg daily) reduced stiffness and pain, and increased grip strength. When taken daily for 1.5 years, meloxicam was deemed safe, but 1/3 experienced stomach side effects [14].

Meloxicam is also available as an injection. Meloxicam injections into the muscles produced equally good results as pills, in a study of 173 patients with RA (double-blind randomized controlled trial), reducing sudden pain and joint stiffness. Injections had some benefits over pills, such as the quicker onset of action [15].

Both commonly used meloxicam doses (7.5 mg and 15 mg) reduced joint pain and overall symptoms when injected, in a study of 472 patients with RA (double-blind randomized controlled trial). But, the 15 mg dose produced a stronger effect on morning stiffness and grip strength [16].

3) Improves Rheumatoid Arthritis in Children

Children under the age of 16 can have juvenile rheumatoid arthritis. In a study of 36 children lasting more than a year, daily meloxicam in liquid form (suspension) was safe, improving pain and stiffness in most participants [17].

4) Reduces Lower Back Pain

Daily meloxicam pills (15 mg) improved lower back pain (lumbago) after a week in a study of 169 patients (randomized controlled trial). Meloxicam starts to act in under an hour, improving everyday movement in patients [18].

Meloxicam injection in the lower back reduced pain in 80 patients after 24 hours (double-blind randomized controlled trial). Three months after the injection, patients were also more active and in less pain [19].

Intravenous (IV) meloxicam is an option for patients in need of immediate pain relief, as they start to act within 30 minutes. In a study(randomized controlled trial) of 183 patients experiencing sudden lower back pain, meloxicam injections (15 mg IV) followed by daily tablets (15 mg) for 8 days reduced pain. Patients on daily meloxicam felt better overall from the treatment [20].

5) Helps with Sciatica

Sciatica can be caused by inflammation or pressure on the sciatic nerves in the lower back, which causes pain. The pain usually extends down [21].

Meloxicam may be a good alternative to opioids for nerve pain relief. In a 6-year study (open-label) of 72 patients with painful nerve inflammation (including sciatica), meloxicam injections (10 mg directly into the nerve root) provided long-term pain relief to all patients after 1 to 3 doses. These patients previously didn’t feel relief from various NSAIDs and opioids [22].

For sudden (acute) pain, oral meloxicam (7.5 mg and 15 mg) reduced pain as much as the standard drug (diclofenac) in 2 studies of 1,021 patients with sciatica (double-blind randomized controlled trial). About half of the participants received daily meloxicam for 7 days and tolerated the drug well [23].

6) Reduces Neck Pain

One to three nerve root injections of meloxicam reduced neck pain in most, and improved recovery, in all 48 patients with severe neck pain in one study (open-label). The patients were previously in pain for more than 3 months despite taking multiple other painkillers (NSAIDs, steroids, acetaminophen, opioids, and gabapentinoids). After meloxicam injections, the pain levels dropped by 81% [24].

7) May Reduce Pain after Dental Surgery

In a study of 60 patients (double-blind randomized controlled trial) with inflammatory gum disease, meloxicam films (10 to 45 mg per film) were applied to the gums after gum surgery for 3 days. Meloxicam reduced post-surgical pain in doses 30 mg and above. The films were convenient for patients and didn’t cause any side effects [25].

Oral meloxicam taken before molar tooth extraction caused less pain and swelling after the extraction when compared to oral diclofenac, in a study of 36 patients (double-blind randomized controlled trial) [26].

Based on many clinical trials (all double-blind randomized controlled trials), there is not enough evidence that oral meloxicam relieves acute post-operative pain in general [27].

8) May Reduce Pain After Surgery

Sometimes painkillers are given before surgery, continuing to reduce pain after the procedure. Meloxicam was given 2 hours before surgery (lower limb) in a study of 70 patients (double-blind randomized controlled trial), half of which received meloxicam (15 mg pills). Meloxicam reduced pain for up to 6 hours after surgery [28].

9) May Prevent Cancer Recurrence

Liver cancer often returns from remission, and meloxicam may play a role in stopping this. Liver cancers contain many COX-2 enzymes, which meloxicam blocks. In a study of 224 patients (randomized controlled trial) meloxicam increased cancer-free survival, but only in patients without hepatitis. Half of the group took meloxicam (15 mg daily) and were tracked for up to 5 years [29].

10) May Reduce Chemotherapy Side Effects

Doxorubicin is a chemotherapy drug used to slow the growth of various cancers, but its risks can outweigh the benefits [30].

Doxorubicin alone caused kidney damage and increased inflammation. Meloxicam given at the same time reduced the damage, protected the kidneys, and acted as an antioxidant [30].

11) May Protect the Liver

In mice with liver injury, meloxicam restored liver activity, reduced markers of damage (AST, ALT, and total bilirubin), and increased antioxidant levels [31].

Meloxicam also helped recover the liver in rats with liver scarring. It reduced markers of damage, inflammation (NF-κB, TNF-alpha, prostaglandins), and scarring. Its antioxidant effect protected the cells by reducing oxidative stress [32].

12) May Protect the Brain

People with Alzheimer’s disease may have high COX-2 levels in the brain [33].

Meloxicam protected the brain and improved learning and memory in a mice model of Alzheimer’s disease. It increased antioxidant levels and boosted compounds important for learning (acetylcholine). Meloxicam produced even better results combined with another drug, selegiline (indicated for Parkinson’s disease) [33].

In another study of mice with Alzheimer’s disease, meloxicam protected the part of the brain important for memory (hippocampus). It improved learning and reduced brain injury [34].

13) May Help Fight Cancer

Meloxicam prevented bladder cancer in mice, although the effect was small. Meloxicam was safe, as it didn’t injure the kidneys or liver [35].

Meloxicam also stopped the spreading and growth of cancers in several cell studies, affecting cancers of the bladder, liver, and bones. It increased autophagy and other processes important for combating cancer in the body (such as apoptosis/cell death). Its effect on blocking COX-2 may also play a cancer-fighting role [35, 36, 37].

Meloxicam Side Effects

Possible side effects of meloxicam include:

  • Rapid weight gain [38]
  • Swelling of the hands, ankles, and/or feet [38]
  • Numbness or weakness on one side of the body [38]
  • Severe and/or sudden headaches [38]
  • Severe stomach pain, nausea, and vomiting [38]
  • Bloody, black, tarry, and/or pale stools [38]
  • Loss of appetite [38]
  • Yellow skin or eyes [38]
  • Painful, less frequent urination, or dark urine [38]
  • Chest pain and trouble breathing [38]
  • Skin blistering, itching, peeling, rashes, or hives [38]
  • Allergic reactions [38]

Serious side effects (such as stomach injury and bleeding) are rare, usually seen in less than 2 people in 1,000 [39].

People with allergies (skin rashes or irritation) to anti-inflammatory medication may tolerate meloxicam better. In a study of 177 patients (single-blind controlled trial) with skin allergies to anti-inflammatory medication, only 1.1% had an allergic reaction to meloxicam [40].

Warnings

Warnings and precautions with meloxicam include [41]:

  • Increased risk for serious cardiovascular (CV) complications including heart attack and stroke.
  • Increases risk for serious gastrointestinal (GI) complications including ulcers and bleeding.
  • Increased risk for elevated liver enzymes.
  • Increased risk for the development or worsening of high blood pressure (HBP).
  • Increased risk for edema (fluid accumulation/retention).
  • Increased risk for kidney injury with long-term use.
  • Increased risk for skin reactions.

Contraindications

You should not take meloxicam if you have had any of the following [41]:

  • Hypersensitivity to meloxicam
  • Any allergies to aspirin or other NSAIDs

Pregnancy and Breastfeeding

There are no studies available about the potential effects of meloxicam in breastfeeding. It is best to use caution and speak to your doctor about your options.

Drug Interactions

  • Aspirin – Use of meloxicam together with aspirin (even at low doses) is not recommended and can increase the risk of stomach damage [42].
  • ACE Inhibitors – Meloxicam can reduce the blood pressure-lowering effect of ACE inhibitors [43].
  • Lithium – Meloxicam may dangerously increase lithium levels, causing overdose [5].
  • Warfarin – There is an increased risk of severe bleeding (internal or external) in combination with meloxicam [44].

Meloxicam Dosage

Meloxicam is available as tablets (5 mg, 7.5 mg), capsules, and via injections (IV or IM).

Gels and patches are also being developed [45, 46].

For Mobic, patients with osteoarthritis pain should take 7.5 mg once daily. Patients may take up to 15 mg once daily only if the osteoarthritic pain is severe [47, 48].

For the newer, lower-dose formulation Vivlodex, patients with osteoarthritis pain should start with a single daily dose of 5 mg orally. Going over 10 mg per day is not recommended, but is an option if the pain is severe. For patients on hemodialysis, the maximum Vivlodex dosage per day is 5 mg [49, 50].

Compared to Other Drugs

Meloxicam vs. Celecoxib

In a study of 70 patients (double-blind randomized controlled trial), meloxicam was compared to celecoxib in reducing pain after surgery. Half of the participants received either treatment (meloxicam 15 mg or celecoxib 400 mg) 2 hours before surgery. Both drugs reduced pain well, meloxicam having a faster and stronger effect, but providing shorter pain relief [28].

Meloxicam vs. Other NSAIDs

In a large study in 8,656 patients with worsening osteoarthritis (double-blind randomized controlled trial), meloxicam caused fewer side effects than piroxicam. Half of the participants received daily meloxicam (7.5 mg) for almost 1 month and experienced less stomach and gut side effects. [51].

Daily meloxicam (15 mg) had less stomach side effects than piroxicam injections (into the muscle) in another study of 169 patients with lower back pain (randomized controlled trial) [18].

Meloxicam (7.5 mg) caused fewer side effects than naproxen in a study of 379 patients (double-blind randomized controlled trial). Half of the participants who received meloxicam had less stomach and kidney damage and no serious complications. Several patients in the naproxen group developed ulcers and had increased markers of kidney damage, however [13].

In one study of 357 patients with rheumatoid arthritis (double-blind randomized controlled trial), daily meloxicam (7.5 mg) was as safe as other NSAIDs. One in three patients taking meloxicam had stomach side effects, 1 in 5 had muscle, joint, or skin problems, and even less had respiratory side effects [14].

Combinations with Supplements

L-Carnitine

Meloxicam in combination with L-carnitine protected the kidneys in rats with kidney damage. Given together with standard antibiotic treatment, this combination increased antioxidant defense, reducing cell damage and inflammation [52].

Melatonin

In rats with stroke, meloxicam with melatonin protected the brain. Melatonin is a potent antioxidant, while meloxicam also reduces inflammation. This combination improved stroke symptoms more than melatonin or meloxicam alone [53].

Limitations and Caveats

Meloxicam improves symptoms but does not cure osteoarthritis or rheumatoid arthritis [54].

Meloxicam has the desired effect only if taken regularly. It will not continue to provide pain relief once you stop taking it [54].

The low-dose meloxicam (SoluMatrix) study was funded by the maker of the drug (Iroko Pharmaceuticals, LLC) [11].

Research on the effects of meloxicam beyond arthritis is still limited to small studies or animal/cell models.

Natural Options

If you’re looking for natural pain and inflammation relief, you’re not alone. The side effects of drugs like meloxicam can be unbearable for some in the long run.

Luckily, you don’t have to look very far. There are many natural options that work like meloxicam, by blocking COX enzymes and the production of prostaglandins. These are usually safe to use alongside conventional drugs.

For a complete list of natural options, check out our article on natural cox inhibitors.

We compiled the best-researched natural options below.

But remember: You should always consult your doctor before changing or stopping your medications.

It’s also important to let your doctor know of all the supplements you are currently taking, in case of potential interactions.

1) Fish Oil

The health benefits of fish oil are mostly attributed to DHA and EPA, two types of omega-3 fatty acids [55].

Similar to meloxicam, fish oils reduce levels of COX-1 and COX-2, leading to a lower number of prostaglandins. It can also decrease other inflammatory compounds like IL-6, TNF-α, and CRP [56, 57].

In a study of 250 people, 60% of those taking fish oil reported that their overall pain was improved [58]

On top of that, 59% of people stopped taking their prescription NSAIDs and 88% said they would continue taking fish oil [58].

According to a review of 42 clinical trials, fish oil is effective for rheumatoid arthritis, but not for osteoarthritis [59].

Other studies suggest that fish oil may also help with menstrual cramps and diabetic neuropathy [60, 61].

2) White Willow Bark

White willow bark (Salix alba) contains salicin, the compound that aspirin is derived from. It’s no surprise then that willow bark extracts can inhibit COX enzymes, much like aspirin [62, 63].

A review of 14 clinical trials involving 2,050 participants found that white willow bark reduces pain more than placebo [64].

In a study of 436 people, willow bark extract reduced pain scores by 33%-44% in those with back pain [65].

Other research has found similar results. No side effects were reported in any of the studies [66, 67].

However, willow bark shares many of the same safety concerns with aspirin, including interactions with blood thinners and a risk of Reye’s syndrome in children [68, 66].

3) Resveratrol

Resveratrol is a compound found in many foods, like berries, peanuts, and most famously in red wine [69].

Animal studies have revealed a wide array of potential health benefits with resveratrol, but it’s not clear if these effects translate to humans [70].

A study of 80 postmenopausal women found that resveratrol reduces chronic pain [71].

Resveratrol may also be effective as an add-on to conventional NSAIDs. In a study of 110 people with osteoarthritis of the knee, resveratrol plus meloxicam provided more pain relief than meloxicam alone [72].

Research in animals has identified more benefits, such as improvements to cancer-related bone pain, neuropathic pain, and pain from burn injuries [73, 74, 75].

The pain-relieving effects of resveratrol are likely due to its ability to reduce the expression of COX-2 [76, 77].

4) Boswellia

The resin of the Boswellia tree, also known as frankincense, has long been recognized for its anti-inflammatory effects [78].

The compounds inside Boswellia can inhibit COX-2, similar to NSAIDs like meloxicam [79, 80].

According to a review of 69 studies, Boswellia extract provides significant short-term pain relief. However, most of the included studies were of low quality [81].

Other reviews have found similar promising results, but they all state that better clinical trials are needed [82, 83].

One of the issues with taking Boswellia is that it has poor bioavailability and absorption [84].

In one study of 52 rugby players, researchers tested a lecithin-based delivery form of Boswellia designed to improve absorption. This formulation was able to improve local pain, walking pain, and structural damage [85].

5) Curcumin

Curcumin is one of the active compounds found inside turmeric [86].

Animal studies show that curcumin decreases the expression of COX-2. It also suppresses the activation of NF-κB, which can also help reduce inflammation [87, 88]

Curcumin may help with arthritis pain, according to a review of 8 clinical trials [89].

A small study of 17 people found that curcumin supplements help with post-exercise muscle soreness [90].

In a different study of 90 patients, it reduced post-surgery pain caused by the removal of impacted molars [91].

According to research done in animals, curcumin may also slow osteoarthritis progression and reduce neuropathic pain [92, 93].

6) Pycnogenol

Pycnogenol is the patented name of an extract made from the French maritime pine bark (Pinus pinaster) [94].

It is able to inhibit both COX-1 and COX-2, according to research in humans [95, 96].

Based on a study of 100 people, Pycnogenol improves the symptoms of mild to moderate osteoarthritis [97].

Pycnogenol reduces muscle pain and cramps, according to a study of 66 subjects [98].

It also may reduce the pain associated with pregnancy [99].

Multiple clinical trials have found that Pycnogenol reduces menstrual pain and the number of bleeding days as well [100, 101, 102].

Want More Targeted Ways to Combat Inflammation?

If you’re interested in natural and more targeted ways of lowering your inflammation, we at SelfHacked recommend checking out this inflammation wellness report. It gives genetic-based diet, lifestyle and supplement tips that can help reduce inflammation levels. The recommendations are personalized based on your genes.

SelfDecode is a sister company of SelfHacked. The proceeds from your purchase of this product are reinvested into our research and development, in order to serve you better. Thank you for your support.

About the Author

Mathew Eng, PharmD

PharmD

Mathew received his PharmD from the University of Hawaii and an undergraduate degree in Biology from the University of Washington.

Mathew is a licensed pharmacist with clinical experience in oncology, infectious disease, and diabetes management. He has a passion for personalized patient care and believes that education is essential to living a healthy life. His goal is to motivate individuals to find ways to manage their chronic conditions.

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