Meloxicam effective on a limited basis
DEAR DOCTOR: I’ve suffered joint pain for years. Being prescribed 15 milligrams of meloxicam has been wonderful. What are your thoughts on meloxicam use?
DEAR READER: Meloxicam (Mobic) is a non-steroidal anti-inflammatory drug (NSAID) that, like all such drugs, inhibits the formation of the enzyme cyclooxygenase (COX). This inhibition leads to a decrease in the production of molecules that boost inflammation and help the blood clot.
There are two forms of the COX enzyme: COX-1 and COX-2. COX-1 is involved in protecting the lining of the stomach, promoting the blood’s clotting ability and aiding kidney function. COX-2 is involved in the inflammatory response in the body. Many of the side effects seen with older NSAIDs such as ibuprofen, naproxen and diclofenac are related to the inhibition of COX-1. The side effects include gastritis or gastric ulcers, blood thinning and kidney damage. Inhibiting COX-2 leads to a decrease in inflammation and a decrease in pain.
Meloxicam at low doses (7.5 milligrams) inhibits COX-2 and not COX-1. That means it can reduce pain and inflammation without irritation of the stomach
lining or an increased risk of stomach ulcers.
Further, at low doses, meloxicam may not trigger the kidney problems that other NSAIDs cause. The rates of heart attacks appear comparable to those of other NSAIDs, with a slight increase in risk at all doses.
However, when meloxicam dosage is increased to 15 mg, the medication does inhibit COX-1, leading to a significant increase in the rates of serious upper gastrointestinal events.
For people on two types of blood pressure drugs — ACE-inhibitors and angiotensin receptor blockers — meloxicam (like other NSAIDs) may make those medications less effective.
I don’t know how frequently you are using meloxicam, but if you’re using it on an as-needed basis, it should be safe. If you’re using this medication daily, you should consider its potential for side effects.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.
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