Adverse Side Effects of Meloxicam

If you have arthritis, your doctor may recommend a trial of meloxicam. Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID) available only by prescription. It is approved by the U.S. Food and Drug Administration (FDA) for the treatment of osteoarthritis, rheumatoid arthritis and juvenile rheumatoid arthritis. As an anti-inflammatory, meloxicam reduces pain and inflammation.

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Like other NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Anaprox, Naprosyn), the most common adverse side effects of meloxicam are digestive tract symptoms, such as diarrhea, nausea and dyspepsia. Meloxicam has several less common -- but serious -- side effects as well. Talk to your doctor if you develop any of the common side effects while taking meloxicam. Seek immediate medical attention if you think you are experiencing a serious side effect.

Common Side Effects

According to the FDA-approved prescribing information, the most common side effects of meloxicam are diarrhea, dyspepsia, upper respiratory tract infections and flu-like symptoms. They have been reported in more than 5 percent of people receiving the drug during research studies. Nausea, flatulence and insomnia are also relatively common. Considered as a group, digestive tract symptoms are the most common side effects, occurring in about 20 percent of people. Many common side effects will improve after a few days as your body becomes used to the drug.

Serious Digestive Tract Effects

The FDA has issued a black box warning indicating that all NSAIDs increase the likelihood of serious digestive tract effects, including bleeding, ulcers and perforation of the stomach or intestines. Bleeding can produce vomit that looks like coffee grounds and stools that look like tar. Peptic ulcers -- open sores in the walls of the stomach or intestines -- produce abdominal pain and bleeding. Perforation of the stomach or intestines occurs when a deep ulcer extends through the wall of these organs. Abrupt onset of severe abdominal pain, nausea, vomiting and weakness suggest that perforation has occurred.

Serious digestive tract effects of NSAIDs are more common in older individuals. Meloxicam poses an average risk of these effects, when compared to other NSAIDs. A study published in the December 2012 issue of "Drug Safety" noted that the risk of serious digestive tract effects was about 3.5 higher with meloxicam than with placebo. For ibuprofen, the risk was lower -- about 1.8 higher than with placebo. For naproxen, the risk was roughly similar -- about 4 times higher than with placebo. For piroxicam (Feldene), the risk was greater -- about 7.5 times higher than with placebo.

Cardiovascular Effects

The FDA has also issued a black box warning indicating that all NSAIDs may increase the likelihood of serious cardiovascular events caused by blood clots, called arterial thrombotic events. These events include myocardial infarctions and strokes. They are more likely with prolonged use of NSAIDs and in people with known cardiovascular disease or risk factors for cardiovascular disease.

According to the FDA-approved prescribing information, the risk of thrombotic cardiovascular events is generally similar for all NSAIDs. A study published in the June 2013 issue of "Pharmacoepidemiology and Drug Safety" looked at the risk of just myocardial infarction. The researchers found that the risk was about 1.3 times higher with meloxicam than with placebo. The risk of myocardial infarction was about 1.1 times higher with ibuprofen than with placebo and also about 1.1 times higher with naproxen than with placebo.

Meloxicam, like all NSAIDs, can lead to an increase in blood pressure. This can produce new hypertension in people with normal blood pressure or worsened hypertension in people with previously diagnosed high blood pressure. As with all NSAIDs, meloxicam may also cause heart failure and fluid retention in some people. This is more likely to occur in people with heart disease.

Liver and Kidney Damage

Similar to all NSAIDs, meloxicam may cause a small increase in liver blood tests that indicate the presence of liver damage. Rarely, severe liver damage may occur, with jaundice -- yellowing of the skin and whites of the eyes -- as one of the most obvious symptoms. Periodic blood tests are often performed to detect liver damage at an early stage before it becomes severe.

Kidney damage may also occur with meloxicam. This is another effect common to all NSAIDs. Occasionally the damage is severe, producing renal failure. Kidney damage is most common in people who are older or have preexisting kidney disease or heart failure. Taking water pills and some types of blood pressure medications also increases the likelihood of kidney damage from NSAIDs.

Allergic and Skin Reactions

As with all medications, some people may be allergic to meloxicam. Allergic reactions are uncommon and usually minor. Rarely, a severe allergic reaction -- called anaphylaxis -- occurs. This can produce generalized skin redness or hives, swelling, wheezing, shortness of breath, lightheadedness or fainting. People who are allergic to other NSAIDs may be allergic to meloxicam as well. Because of this, meloxicam should not be taken by people allergic to any NSAID, according to the FDA-approved prescribing information.

All NSAIDS, including meloxicam, can occasionally cause serious skin reactions, including Stevens-Johnson syndrome, exfoliative dermatitis and toxic epidermal necrolysis. These are severe, potentially fatal skin conditions that lead to loss of skin in the involved areas.

Reviewed and revised by Mary D. Daley, M.D.

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