Meloxicam in modern NSAID therapy: a balance of efficacy and safety

Meloxicam is a nonsteroidal anti-inflammatory drug with preferential COX-2 selectivity, combining effective analgesic and anti-inflammatory action with a lower risk of gastrointestinal complications and a favorable cardiovascular safety profile. Clinical evidence demonstrates good tolerability and a reduced incidence of gastrointestinal adverse events at standard doses, without a significant increase in cardiovascular risk in patients with moderate risk. The orodispersible form provides faster pain relief, ease of use, and may improve patient adherence, expanding the possibilities for safe long-term NSAID therapy.

References

1. Kolasinski S.L., Neogi T., Hochberg M.C. et al. (2020) 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care & Research, 72(2): 149–162.
2. Smolen J.S., Landewé R.B.M., Bijlsma J.W.J. et al. (2022) EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann. Rheum. Dis., 82(1): 3–18.
3. Bannuru R.R., Osani M.C., Vaysbrot E.E. et al. (2019) OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11): 1578–1589. doi.org/10.1016/j.joca.2019.06.011.
4. Jones C.M.P., Underwood M., Chou R. et al. (2024) Analgesia for non-specific low back pain. BMJ, 385: e080064. doi.org/10.1136/bmj-2024-080064.
5. da Costa B.R., Pereira T.V., Saadat P. et al. (2021) Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: Network meta-analysis. BMJ, 375: n2321. doi.org/10.1136/bmj.n2321.
6. Ma C.H., Tworek K.B., Kung J.Y. et al. (2023) Systemic nonsteroidal anti-inflammatories for analgesia in postoperative critical care patients: A systematic review and meta-analysis. Critical Care Explorations, 5(7): e0938.
7. Samartsev I.N., Zhivolupov S.A., Nazhmudinov R.Z. et al. (2019) Identification of non-steroidal anti-inflammatory drugs as a basis for correlating effectiveness and risks. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova, 119(12): 124–131.
8. JiaoYi P., YongQi S., KeChun G. et al. (2025) Assessing the efficacy and safety of different NSAIDs in osteoarthritis: A network meta-analysis. PLoS One, 20(5): e0320379.
9. Monteiro C., Silvestre S., Duarte A.P. et al. (2022) Safety of non-steroidal anti-inflammatory drugs in the elderly. International Journal of Environmental Research and Public Health, 19(6): 3541. doi.org/10.3390/ijerph19063541.
10. Leal-Ramos O.J., Arias-Ruiz L.F., Huerta-Velázquez J.M. et al. (2025) Mechanisms involved in the adverse cardiovascular effects of COX-2 inhibitors. Cardiovascular Medicine, 28(1): 5. doi.org/10.3390/cardiovascmed28010005.
11. Roshandel F., Vithanala S.R., Kandula S.K., Roshandel A. (2025) Comparative cardiovascular safety of NSAIDs and COX-2 inhibitors. J. Emerg. Health Care, 14(1): 43.
12. Ikdahl E., Kerola A., Sollerud E., Semb A.G. (2024) Cardiovascular implications of NSAIDs. European Cardiology Review, 19: e27. doi.org/10.15420/ecr.2024.24.
13. Pawlędzio S., Ziemniak M., Wang X. et al. (2025) Selectivity of NSAIDs for cyclooxygenases using quantum crystallography. IUCrJ, 12(2): 208–222.
14. Hopkins S., Yang V., Liew D.F.L. (2025) Choosing a nonsteroidal anti-inflammatory drug for pain. Australian Prescriber, 48: 139–144.
15. National Institute of Diabetes and Digestive and Kidney Diseases (2025) Meloxicam. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. http://www.ncbi.nlm.nih.gov/books/NBK548278.
16. Поворознюк В.В., Дзерович Н.І., Заверуха Н.В. та ін. (2020) Ефективність та безпечність мелоксикаму у хворих на остеоартроз колінних суглобів. Біль. Суглоби. Хребет, 10(4): 9–18.
17. Шуба Н.М., Воронова Т.Д., Крилова А.С. (2017) Порівняльна оцінка мелоксикаму при болю в нижній частині спини. Здоров’я України, 18(415).
18. Бистрицька М.А., Мусієнко А.С., Заверуха Н.В. та ін. (2022) Безпечність та ефективність мелоксикаму при болю в нижній частині спини. Біль. Суглоби. Хребет, 12(4): 1–4.
19. Qmiiz ODT — An orally disintegrating meloxicam tablet (2019) Medical Letter on Drugs and Therapeutics, 61(1581): 151–152.
20. Nagai N., Ogata F., Otake H., Kawasaki N. (2020) Oral administration system based on meloxicam nanocrystals. Pharmaceutics, 12(4): 313.
21. Abdelmonem R., Abdellatif M.M., Al-Samadi I.E.I., El-Nabarawi M.A. (2021) Formulation and evaluation of meloxicam ODTs. Drug Design, Development and Therapy, 15: 4383–4402. doi.org/10.2147/DDDT.S327193.
22. Panchal N.K., Prince Sabina E. (2023) NSAIDs: Molecular mechanisms of organ toxicities. Food and Chemical Toxicology, 172: 113598.
23. Yang L., Akanyibah F.A., Yao D. et al. (2025) COX-2 as a therapeutic target in IBD. Archives of Biochemistry and Biophysics, 771: 110516. doi.org/10.1016/j.abb.2025.110516.
24. Chakravarthi S., Karthekeyan R., Gopalakrishna P.K. et al. (2025) Anti-inflammatory mechanisms of COX-2 inhibitors. Journal of Pharmacology, Genetics and Molecular Biology, 34–48. doi.org/10.64062/JPGMB.Vol1.Issue4.4.
25. Shirakawa K., Takeno M., Kuma H. et al. (2025) Comparative evaluation of cyclooxygenase inhibition profiles. Pain and Therapy, 14(1): 329–338.
26. Khalil N.A., Ahmed E.M., Tharwat T., Mahmoud Z. (2024) NSAIDs between past and present. RSC Advances, 14(42): 30647–30661. doi.org/10.1039/d4ra04686b.
27. Davies N.M., Skjodt N.M. (1999) Clinical pharmacokinetics of meloxicam. Clinical Pharmacokinetics, 36(2): 115–126. doi.org/10.2165/00003088-199936020-00003.
28. Alhammadi N., Asiri A.H., Alshahrani F.M. et al. (2022) Gastrointestinal complications associated with NSAID use. Cureus, 14(6): e26154. doi.org/10.7759/cureus.26154
29. Henry D., McGettigan P. (2003) Gastrointestinal and renal toxicity of NSAIDs. International Journal of Clinical Practice, 135: 43–49.
30. Hawkey C., Kahan A., Steinbrück K. et al. (1998) Gastrointestinal tolerability of meloxicam. British Journal of Rheumatology, 37(9): 937–945.
31. Schoenfeld P. (1999) Gastrointestinal safety profile of meloxicam. American Journal of Medicine, 107(6A): 48S–54S. doi.org/10.1016/S0002-9343(99)00367-8.
32. Barner A. (1996) Benefit/risk ratio of meloxicam. Scandinavian Journal of Rheumatology Supplement, 102: 29–37. doi.org/10.3109/03009749609097228.
33. Tawfik A.G., Gomez-Lumbreras A., Del Fiol G. et al. (2026) NSAIDs and gastrointestinal bleeding risk. Clinical Pharmacology & Therapeutics, 119(1): 46–62.
34. Degner F., Sigmund R., Zeidler H. (2000) Efficacy and tolerability of meloxicam. Clinical Therapeutics, 22(4): 400–410. doi.org/10.1016/S0149-2918(00)89009-8
35. U.S. Food and Drug Administration (2024) Highlights of prescribing information: Meloxicam.
36. Schmidt M., Lamberts M., Olsen A.M. et al. (2016) Cardiovascular safety of NSAIDs. European Heart Journal — Cardiovascular Pharmacotherapy, 2(2): 108–118.
37. Викторов А.П. (2003) Побочное действие НПЗП. УМЧ, 1(33): 79–89.
38. European Medicines Agency (2012) Assessment Report for Nimesulide, EMA/73856/2012.
39. Gulmez S.E., Moore N., Pageaux G.P., Lignot S. et. al. (2013) Causality of Drugs Involved in Acute Liver Failure Leading to Transplantation: Results from the Study of Acute Liver Transplant (SALT). Drug Saf., 36(9): 757–64.
40. Schmidt M., Sørensen H.T., Pedersen L. (2022) Cardiovascular risks of diclofenac. Drug Safety, 45(9): 983–994. doi.org/10.1007/s40264-022-01211-1.
41. Chesné C., Guyomard C., Guillouzo A. et al. (1998) Metabolism of meloxicam in human liver. Xenobiotica, 28(1): 1–13. doi.org/10.1080/004982598239704.
42. McLaughlin R., Grother L., Bayru M. (2016) Orally disintegrating tablets: dosage form overview. American Pharmaceutical Review.
43. Orally disintegrating tablets: A short review (2019) EMU Journal of Pharmaceutical Sciences, 1(1): 76–81. doi.org/10.15744/2348-9782.3.303.
44. Haffar A., Fillingham Y.A., Breckenridge L. et al. (2022) Meloxicam vs celecoxib after knee arthroplasty. JAAOS Global Research & Reviews, 6(4): e22.00032.
45. Asghar W., Jamali F. (2015) COX-2-selective meloxicam and cardiovascular risk. Inflammopharmacology, 23(1): 1–16. doi.org/10.1007/s10787-014-0225-9.
46. Schmidt M., Sørensen H.T., Pedersen L. (2022) Cardiovascular risks of diclofenac versus COX-2 inhibitors. Drug Safety, 45(9): 983–994.
47. Coxib and Traditional NSAID Trialists’ Collaboration (2013) Vascular and gastrointestinal effects of NSAIDs. The Lancet, 382(9894): 769–779.
48. Singh G. (2001) Meloxicam and cardiovascular risk. Annals of the Rheumatic Diseases, 60(Suppl 1): A445. doi.org/10.1136/annrheumdis-2001.802.
49. Schmidt M., Lamberts M., Olsen A.M. et al. (2016) Cardiovascular safety of NSAIDs. European Heart Journal — Cardiovascular Pharmacotherapy, 2(2): 108–118.
50. Dingle J.T. (1999) NSAIDs in osteoarthritis treatment. In: Osteoarthritis: Clinical and Experimental Aspects: 370–387. Springer.
51. Blot L., Marcelis A., Devogelaer J.-P. et al. (2000) Effects of NSAIDs on cartilage metabolism. Br. J. Pharmacol., 131(7): 1413–1421.
52. Поворознюк В.В. (2011) Лікування болю та запалення. Укр. ревм. журн., 1(43): 91–95.
53. Шуба Н.М., Воронова Т.Д., Крилова А.С. (2019) Форми мелоксикаму при остеоартрозі. Ліки України, 7(233): 5–11.
54. Балабанова Р.М., Егорова О.Н. (2011) Мелоксикам при остеоартрозі. Здоров’я України, 1: 4.
55. Rainsford K.D., Ying C., Smith F.C. (1997) NSAIDs and cartilage metabolism. J. Pharmacy Pharmacol., 49: 991–998.
56. Rainsford K.D., Skerry T.M., Chindemi P. et al. (1999) NSAIDs and joint responses. Veterinary Research Communications, 23: 101–113. DOI: 10.1023/a:1006254402163.
57. Rainsford K.D., Ying C., Smith F.C. (1999) Side effects of NSAIDs. Am. J. Med., 107(6A): 27–35.
58. Sadowski T. (2001) NSAIDs and matrix metalloproteinases. Osteoarthritis and Cartilage, 9(5): 407–415. DOI: 10.1053/joca.2000.0406.
59. Blot L., Marcelis A., Devogelaer J.P. et al. (2002) NSAIDs and osteoarthritis progression. Inflammation, 26(3): 139–142.
60. Chu S.C., Yang S.F., Lue K.H. et al. (2008) NSAIDs and enzyme expression in osteoarthritis. Clinica Chimica Acta, 387(1–2): 90–96.
61. Kloppenburg M., Kroon F.P., Blanco F.J. (2019) EULAR recommendations for hand osteoarthritis. Ann. Rheum. Dis., 78(1): 16–24.
62. Orally disintegrating tablets: A short review (2019) EMU J. Pharmaceut. Sci., 1(1): 76–81.
63. Rostom A., Goldkind L., Laine L. (2005) NSAIDs and hepatic toxicity. Clin. Gastroenterol. Hepatol., 3(5): 489–498.