Meloxicam

Is meloxicam safe?

For most adults with arthritis, yes, at the dose on the label and with an eye on the stomach. Meloxicam is now the most prescribed NSAID in the US, with about 19.7 million prescriptions in 2024, more than ibuprofen on prescription. Doctors like it because one small tablet a day is enough.

That convenience can make it seem gentler than it is. Meloxicam carries the same boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary for heart attack, stroke and stomach bleeding as every prescription NSAID, and in population studies its stomach risk sat closer to diclofenac than to ibuprofen. We score it 73, a point below ibuprofen and celecoxib (74) and level with naproxen.

Why once a day matters

Meloxicam's half-life is 15 to 20 hours, while over-the-counterOver-the-counterA medicine you can buy without a prescription, in a pharmacy or shop, with directions on the pack for safe use without a doctor.More in the glossary ibuprofen is taken every 4 to 6 hours. One dose keeps working through the day and night, which helps with morning stiffness. It also means the drug is in your blood all the time, and that is the pattern that wears down the stomach lining.

The capsules are absorbed differently, and the label says they cannot be swapped milligram for milligram with tablets. Severe kidney disease is a reason not to use meloxicam at all.

The stomach is the main risk

The best comparison across NSAIDs comes from observational studies of real patients, because few trials pit meloxicam against the others. In 2012 the European SOS project pooled 28 such studies of serious upper stomach complications: bleeding, perforation and blocked ulcers.

Across the drugs, high daily doses carried two to three times the risk of low doses, so the step from 7.5 mg to 15 mg is worth discussing with your doctor. The label puts the class figure at about 1% of patients with an ulcer or bleed after 3 to 6 months of use, more in older people and anyone who has had an ulcer before. A stomach-protecting medicine such as omeprazole is common for people at high risk; ask your doctor whether you need one.

What about the heart?

The data are thinner than for ibuprofen, naproxen or celecoxib. A 2011 review of population studies found meloxicam raised the risk of heart attacks and strokes by about 20% (7 studies), much like ibuprofen (18%) and well below diclofenac (40%). Naproxen came out lowest, at 9%. The authors called the meloxicam data sparse, and no trial has tested it the way PRECISION tested celecoxib.

So the honest answer is that meloxicam probably carries the usual NSAID heart risk, no better and no clearly worse. That risk can start in the first weeks of use and rises with dose. All NSAIDs, meloxicam included, can raise blood pressure and bring on heart failure in people who are prone to it.

Kidneys, liver and skin

NSAIDs reduce blood flow to the kidneys, and the risk is highest in older people, those who are dehydrated, and anyone also taking a diuretic with an ACE inhibitor or ARB. The label says to avoid meloxicam in severe kidney disease. Small rises in liver enzymes are common, about 1% of NSAID users have rises above three times normal, and fatal liver injuryDrug-induced liver injuryLiver damage caused by a medicine, herbal product or supplement. It is usually rare and unpredictable, but it can be serious.More in the glossary is rare.

Serious skin reactions, including Stevens-Johnson syndrome and DRESS, are rare but can be fatal. The label was updated in July 2024 to strengthen these warnings. Stop the medicine and get medical advice at the first sign of a rash, blisters or fever with swollen glands.

Who should be careful

Talk to your doctor before starting or continuing meloxicam if you:

• have had a heart attack, stroke, heart failure or bypass surgery, or have poorly controlled blood pressure
• have had a stomach ulcer or bleed, or take a blood thinner, a steroid, an SSRI or low-dose aspirin
• have kidney disease or are on dialysis
• have had asthma, hives or swelling after aspirin or another NSAID
• take lithium or methotrexate
• are pregnant or trying to conceive

Do not take meloxicam with other NSAIDs, including over-the-counterOver-the-counterA medicine you can buy without a prescription, in a pharmacy or shop, with directions on the pack for safe use without a doctor.More in the glossary ibuprofen, naproxen and aspirin for pain. An overdose is rarely life-threatening, but call Poison Control on 1-800-222-1222 in the US or NHS 111 in the UK. A lower score is no reason to stop a medicine your doctor prescribed; ask at your next review whether you still need it and at what dose.

How we scored it

Dependence (97), track record (90) and overdose marginOverdose marginHow far a normal dose is from a harmful one. A wide margin means an accidental extra dose is unlikely to cause serious harm.More in the glossary (85) are strong. Serious side effects (62) sit just below naproxen and ibuprofen because meloxicam's stomach risk in real-world studies is close to diclofenac's, while its heart risk looks average for the class. Regulatory warnings (45) reflect the boxed warningBoxed warningThe strongest safety warning the US FDA puts on a medicine's label, printed inside a black border at the top.More in the glossary that every prescription NSAID carries.