Users Online: 1041 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 

RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to preferably by 30th June 2019.


Table of Contents
Year : 2018  |  Volume : 34  |  Issue : 4  |  Page : 450-457

Meloxicam in the management of post-operative pain: Narrative review

Department of Anesthesiology, Rutgers-New Jersey Medical School, Newark, NJ, USA

Date of Web Publication3-Jan-2019

Correspondence Address:
Alex Bekker
Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, NJ
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joacp.JOACP_133_18

Rights and Permissions

Oral formulations of meloxicam, a preferential cyclooxygenase-2 (COX-2) inhibitor, have long been used to treat osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, as well as various pain syndromes of skeletomuscular origin (e.g., low back pain). However, these preparations are rarely indicated for the treatment of acute pain due to a poor dissolution rate and consequently a slow onset of action. The recent introduction of an intravenous (IV) NanoCrystal Colloidal Dispersion formulation opens up the possibility of using this drug during the perioperative period. The present review summarizes the pharmacologic properties of meloxicam, including its pharmacokinetics, adverse effects, and tolerability. In addition, we critically examined a number of recently completed clinical trials that evaluated the efficacy and safety of meloxicam IV in the treatment of post-operative pain. Literature retrieval was performed through PubMed and Medline (through March 2018) using combinations of the terms meloxicam, acute pain, and pharmacology. In addition, bibliographical information, including contributory unpublished data, was requested from the company developing the drug. Clinical trials suggest that single IV doses of 30 mg meloxicam significantly reduce post-operative pain as well as opioid requirements. We conclude that meloxicam IV is an effective and well-tolerated analgesic agent for the management of moderate to severe post-operative pain.

Keywords: Acute pain, intravenous, meloxicam, pharmacology

How to cite this article:
Bekker A, Kloepping C, Collingwood S. Meloxicam in the management of post-operative pain: Narrative review. J Anaesthesiol Clin Pharmacol 2018;34:450-7

How to cite this URL:
Bekker A, Kloepping C, Collingwood S. Meloxicam in the management of post-operative pain: Narrative review. J Anaesthesiol Clin Pharmacol [serial online] 2018 [cited 2020 Sep 29];34:450-7. Available from:

  Introduction Top

Post-operative pain is an expected consequence of surgery. Although opioid analgesics have been the primary therapy for treating acute pain, they are associated with a multitude of adverse effects, including respiratory depression, nausea and vomiting, ileus, urinary retention, pruritus, as well as concerns over potential addiction.[1] Therefore, the “Practice Guidelines for Acute Pain Management in the Perioperative Setting” adopted by the American Society of Anesthesiology (as well as numerous other relevant organizations) recommend multimodal strategies for the management of post-operative pain. More specifically, the guidelines state that “unless contraindicated, patients should receive an around-the-clock regimen of Non-steroidal Anti-inflammatory Drugs (NSAIDs), COX-2 inhibitors (COXIBs), or acetaminophen.”[2]

Meloxicam, an enol-carboxamide non-steroidal anti-inflammatory drug (NSAID) related to piroxicam, has long been used to treat acute pain and inflammation. In contrast to other NSAIDs, it has a greater inhibitory activity against the inducible isoform of cyclooxygenase (COX-2) than against the constitutive isoform (COX-1).[3] COX-1 induces the synthesis of prostacyclin, which is responsible for vascular homeostasis, platelet aggregation, renal function, and gastric cytoprotection. The expression of COX-2 isoform increases during inflammation. Consequently, although meloxicam's anti-inflammatory and analgesic properties are similar to non-selective NSAIDs, it has both gastric mucosal and renal protective properties.[4]

Oral formulations of meloxicam are widely used to treat osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, as well as various pain syndromes of skeletomuscular origin (e.g., low back pain). The half-life of meloxicam is approximately 20 hours. Maximum meloxicam plasma concentration following oral administration (patient in fasted state) was achieved after approximately 10 hours for the most part due to its poor dissolution rate.[5] Consequently, oral preparations of meloxicam are rarely indicated for treatment of acute (i.e., post-operative) pain.

A novel intravenous (IV) formulation of NanoCrystal Colloidal Dispersion Meloxicam has recently been developed in the last decade for the management of acute pain.[6] A number of Phase 2 and Phase 3 studies have been recently completed to evaluate the efficacy and safety of IV meloxicam for the treatment of post-operative pain in a number of clinical settings.[7],[8] This article provides an overview of the pharmacological properties of various meloxicam preparations (i.e., oral vs. parenteral vs. transdermal) as well as its clinical efficacy and tolerability in the treatment of post-operative pain in a variety of post-operative pain models. A systematic and comprehensive literature search was conducted through March 2018 using PubMed and Medline for preparation of this review.

  Pharmacokinetic Properties Top


The absorption of meloxicam has been studied following its administration via intramuscular, oral, and rectal routes. The absolute bioavailability (F) was 89% for oral capsules after a single 30 mg dose.[5] Maximum meloxicam plasma concentration (Cmax) was achieved after 5–6 hours (tmax) when administered after breakfast.[9] When administered in a fasting state, the Cmax for meloxicam doubled. When used chronically, NSAIDs are typically administered after a meal; thus, Cmax = 5–6 hours is the more clinically relevant figure. The absorption of meloxicam is independent of the dose over the range 7.5–30 mg, leading to dose-linear increases in meloxicam plasma concentrations.[10] This consideration enables easy dose titration in those patients requiring higher or lower doses than normal.


Meloxicam, like most NSAIDS, is highly protein bound (>99%) to albumin.[11] The binding is consistent over the concentration range encountered in clinical practice. This high protein binding results in a restricted volume of distribution (Vd) of 10–15 l,[10] which is similar to that reported for other NSAIDs.[12],[13] Animal experiments suggest that meloxicam is predominantly distributed to highly perfused (albumin rich) compartments such as the blood, liver, kidney, and so on.[11] The volume of distribution equates approximately with the extracellular space, although meloxicam readily penetrates other tissues. For example, 40–45% of the accompanying steady-state meloxicam plasma concentrations are found in synovial fluid, slightly lower concentrations being observed in the adjacent tissues.[14]


Meloxicam is primarily eliminated by metabolic degradation. It undergoes roughly equal parts of renal and fecal elimination, with <0.25% eliminated unchanged in the urine and 1.6% of the parent compound present in feces.[8] Meloxicam undergoes extensive Phase 1 eliminations, and no conjugated derivatives have been identified. The metabolism of meloxicam is primarily mediated by CYP450 2C, most probably on the isoenzyme 2C9.[15] The main metabolite is formed by the oxidation of the methyl group of the thiazole moiety; it has no metabolic activity.


The total clearance of oral meloxicam is 0.42–0.48 l/h. The elimination half-life (t1/2) is approximately 20 hours, which is relatively short compared to other NSAIDs of the same class.[9] The short t1/2 allows daily dosing without the need for a slow release formulation. NSAIDs such as diclofenac have a short elimination half-life (1–2 hours) and require a slow release formulation for a once-daily regimen. The efficacy of slow release formulations may be influenced by food intake.[9] Diclofenac is a well-known example of variations in concentration profiles based on food intake. Such food effects are rare with compounds like meloxicam due to its longer elimination half-life.

  Pharmacodynamic Properties Top


The anti-inflammatory effects of meloxicam have been demonstrated in rat models such as carrageenan or kaolin-induced rat paw edema, granuloma formation following cotton implantation in rats, kaolin-induced rat pleurisy, and rat adjuvant-induced arthritis.[9],[10] In all models, meloxicam suppressed inflammation at a single dose for a prolonged time. In human studies, meloxicam has been shown to decrease erythrocyte sedimentation rate(ESR) in patients with rheumatoid arthritis,[16] and decrease ESR, C-reactive protein (CRP), and aquaporin-1 expression, serving as an analog to treatment efficacy in ankylosing spondylitis.[17]


Meloxicam showed prolonged effect against inflammatory pain in the rat.[18] Following a single oral administration, the analgesic effect of meloxicam is not reduced by 50% until 18 hours after administration. Meloxicam has a markedly longer duration of action than piroxicam, diclofenac, and indomethacin. Similarly, meloxicam has been used for the treatment of pain secondary to rheumatoid arthritis, osteoarthritis, and periprocedural pain in various human studies since its introduction.


Meloxicam, like all other NSAIDs, has no effect on body temperature in normothermic mammals, because NSAIDs do not directly impact the calorific center. NSAIDs are only influential on pyrogen-induced fever. Meloxicam shows lower potency against yeast-induced pyrexia than diclofenac and piroxicam. At a dose of 0.1 mg/kg, meloxicam was found to reduce endotoxin-induced fever in a cat.[19]

  Perioperative Use of Meloxicam Top

Meloxicam is widely used for the treatment of acute and chronic pain. For example, a number of reviews on the use of this drug for the treatment of osteoarthritis and rheumatoid arthritis have been recently published.[20],[21],[22],[23] In the ensuing discussion, we will focus on the studies which compare pharmacokinetic and efficacy of various meloxicam preparations in the perioperative setting as well as for the treatment of neuropathic pain.

Although oral administration of meloxicam as 7.5 and 15 mg tablet is most common, other methods of meloxicam delivery are available, such as transdermal and IV forms. Product formulation may have a significant impact, not only on absorption rates but also on penetration depth.

Oral route

The use of oral meloxicam has been extensively studied for the treatment of post-operative surgical and dental pain [Table 1]. Single-dose pre-operative oral meloxicam was given to patients undergoing inguinal hernia repair under local anesthesia, with subsequent IV diclofenac administration in the post-operative period if visual analog scale (VAS) was >3.[24] Results showed a statistically significant lower reported value of VAS scores for the group pre-emptively treated with meloxicam and less use of rescue IV diclofenac (36% vs. 88%) in the meloxicam treated group.[24]
Table 1: Summary of oral peri-operative meloxicam use

Click here to view

Thompson et al.[25] conducted a double-blind randomized control study to examine the analgesic effect of meloxicam suppository in patients undergoing a total abdominal hysterectomy. All patients received a morphine patient-controlled analgesia (PCA) post-operatively, and pain scores and morphine usage were evaluated post-operatively. VAS scores were significantly lower in the meloxicam group. PCA morphine usage, however, was not decreased significantly in the treatment group.[25]

Aghadavoudi et al.[26] compared pre-operative dosing of meloxicam (15 mg) and celecoxib (400 mg) for the treatment of pain in a double-blind randomized control study for lower extremity surgery. Pain severity was higher in the first 2 hours in the celecoxib group and 6 hours post-operatively in the meloxicam group, and there was no difference by 12 hours.[26]

A Cochrane review recently attempted to evaluate the efficacy of oral meloxicam in acute post-operative pain, summarizing results from randomized double-blind placebo-controlled clinical trials involving meloxicam for acute post-operative pain relief.[27] Unfortunately, none of the studies examined met inclusion criteria for analysis.

Oral meloxicam has also been widely used and studied for controlling post-procedural pain, swelling, and trismus following dental cases.[28],[29] Orozco-Solís et al.[28] administered pre-procedural meloxicam (15 mg) or diclofenac (100 mg), with results reflecting statistically significant decreased post-operative pain and increased mouth opening in the meloxicam group, as well as an observed but non-significant decrease in swelling in both groups. Calvo et al.[29] compared the effects of 7.5 mg meloxicam versus 15 mg meloxicam, administered in the post-operative period for up to 4 days, for pain following third molar removal. Patients receiving 7.5 mg meloxicam who required osteotomy reported higher pain scores than those who did not require osteotomies and used more rescue analgesics than those without osteotomy.[29] However, in the group which received 15 mg of meloxicam, there was no significant difference in rescue analgesic dosing between osteotomy and non-osteotomy groups.[29] Overall, like in the research findings of Orozco-Solís et al., there was no significant difference in swelling.

Nekoofar et al.[30] administered 15 mg meloxicam, 20 mg piroxicam, or a placebo via randomization pre-operatively to patients with endodontic pain requiring root canal for treatment. The mean change in VAS between pre-dental procedure and 8 hours post procedure was highest in the meloxicam group; however, the overall reduction in pain among meloxicam, piroxicam, and placebo was not significant.[30] Similarly, in a large, prospective, double-blind randomized clinical trial, pre-operative meloxicam (7.5 mg), acetaminophen (650 mg), and ibuprofen (400 mg) were compared for efficacy in reducing pain after separator placement for orthodontic surgery.[31] No statistically significant difference in pain perception scores was found between the three groups, which the authors concluded as indicating equivalent effectiveness of all three drugs for post-separator pain.[31]

Transdermal/transmucosal formulations

Newer preparations of meloxicam have also been examined for post-procedure periodontal and dental impaction surgeries. Transmucosal adhesive meloxicam films were developed and applied to post-periodontal flap surgery over surgical sites for a duration of 4 days at doses of 45, 30, 20, or 10 mg meloxicam per film.[32] There were no reported adverse effects, and all patients noted immediate pain relief with application of the film; pain control was least effective in the 10 mg group and was poor in the 20 mg group. The 45 and 30 mg groups had adequate pain control for the first 24 hours.[32]

A review article by Chen and Gao[33] focused on transdermal delivery of meloxicam, with the premise that application of the drug overlying the area of pain would result in less systemic side effects and avoid first-pass hepatic metabolism. In order for meloxicam to be available via transdermal route, multiple formulations and chemical enhancement techniques have been studied to enhance permeation of meloxicam through the stratum corneum and across the skin. Formulation types include gels, liposomes, patches, microemulsions, and physical approaches including electroporation, iontophoresis, and sonophoresis. Pharmacokinetic studies comparing drug levels of meloxicam in plasma and synovial fluid following oral meloxicam, as well as meloxicam gel administration to hind legs in beagles, revealed higher concentrations in synovial fluid underlying the applied target site compared to oral delivery.[34] Furthermore, in the untreated leg, synovial fluid concentrations of meloxicam were similar to plasma concentrations following oral administration of meloxicam but were less compared to that of the treated leg.[34] Continued research and development of transdermal formulations of meloxicam may yield an alternate therapy option for patients with the potential to cause fewer systemic side effects [Table 2].
Table 2: Summary of transdermal preparations of meloxicam

Click here to view

Intravenous administration

The use of IV meloxicam has been evaluated in the past by Rømsing et al., wherein patients were administered 7.5 mg meloxicam intravenously or received wound infiltration of 7.5 mg meloxicam for post-operative pain control following inguinal hernia repair.[35] Subsequently, a fixed combination of a post-operative pain regimen (acetaminophen plus codeine every 6 hours prn) was given, and if pain control was insufficient, the pain regimen was supplemented with IV fentanyl. Results showed no significant difference in pain scores or use of supplemental analgesics between groups but did show significantly lower plasma concentrations of meloxicam in the local infiltration group compared to the IV group.[35]

More recently, there has been renewed interest in the use of IV meloxicam, with several published studies and ongoing clinical research trials for post-operative pain control for abdominoplasty, orthopedic surgery, podiatric surgery, dental procedures, and other major surgical procedures at doses that differ from the Rømsing study. These studies are described in further detail below [Table 3].
Table 3: Summary of intravenous use of meloxicam

Click here to view

In patients undergoing more than two-third molar removals, patients with significant pain within 5 hours post procedure were randomized to receive IV meloxicam (15, 30, or 60 mg), IV placebo, or PO ibuprofen tablets.[8] Meloxicam IV (60 mg) produced the greatest reduction in pain, followed by meloxicam IV (30 and 15 mg), with more rapid onset of pain relief with IV meloxicam than for ibuprofen and reduced usage of rescue medication; duration of effect lasted for 24 hours.[8]

The use of post-operative IV meloxicam (30 or 60 mg) in 59 patients with moderate to severe pain from unilateral bunionectomy, dosed every 24 hours for up to 3 days, resulted in rapid onset of analgesia and significant decrease in pain intensity compared to placebo; there was no measurable difference between the two doses.[15] Likewise, in 219 patients with pain following abdominoplasty randomized to receive 30 mg IV meloxicam or a placebo dosed daily for 2 days, researchers noted statistically significant pain relief compared to placebo.[36] Rescue dosing of oxycodone in the treatment phase was also significantly lower in the IV meloxicam group compared to the placebo group; there was no difference seen in the time to first rescue dose of oxycodone.[36]

Two recent Phase 3 studies evaluated the effect of post-operative daily IV meloxicam (30 mg) versus placebo on opioid use following orthopedic procedures and major elective surgical procedures.[37],[38] A statistically significant reduction in total opioid use was seen throughout the treatment period in the IV meloxicam group compared to the placebo group.[37]

  Meloxicam for Treatment of Neuropathic Pain Top

A number of studies have been conducted on the role of meloxicam in the management of neuropathic pain. Takeda et al.[39] evaluated the role of spinal COX-2 on the pathophysiology of neuropathic pain by using a continuous intrathecal infusion of meloxicam versus saline following L5/L6 spinal nerve ligation in rats. Intrathecal infusions were evaluated immediately after nerve ligation in the first group; in the second subset, intrathecal infusion was introduced 7 days after ligation; finally, a third subset introduced systemic meloxicam 7 days after ligation.[39] Intrathecal meloxicam did prevent development of neuropathic pain and spinal glial activation, but it did not reverse mechanical allodynia or thermal hyperalgesia. Systemic meloxicam partially reversed existing allodynia and hyperalgesia.[39] The authors concluded that spinal COX-2 may mediate development of neuropathic pain and that peripheral COX-2 may improve the maintenance of neuropathic pain.[39]

Yamamoto et al.[40] evaluated the administration of meloxicam for symptomatic neuropathy (motor or sensory) in patients who were receiving doxorubicin and paclitaxel for breast cancer. Of the 43 patients in the clinical trial, 15 patients developed neuropathy during paclitaxel and received 10 mg meloxicam daily.[40] There was a statically significant reduction in sensory neuropathy in 5 of the 15 patients, but motor neuropathy did not improve after 2 months of meloxicam therapy.[40]

  Tolerability Top


It is widely accepted that gastric ulcerogenicity is an adverse and dose-limiting side effect of all established NSAIDs. It has been shown that the complex pathogenesis of stomach ulcerations accompanying NSAIDs is related to the inhibition of the biosynthesis of cytoprotective prostaglandins (PEs) in the gastric mucosa[19]; specifically, PGE2 and PGI1 protect the mucosa and inhibit acid secretion in the stomach. Meloxicam is a weak inhibitor of PGE2 in the rat stomach and is a much less potent stimulator of gastric acid secretion.

Tolerability of meloxicam compared to other NSAIDs has been extensively evaluated by Zeidler et al.,[41] a study wherein more than 13,000 patients involved in an observational cohort study were followed for 4–12 weeks at doses of 7.5 or 15 mg meloxicam daily to treat osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, or other painful inflammatory disorders of the musculoskeletal system. General tolerability was rated as “very good” or “good” for 94% of the patients. There were two serious adverse events: surgery for perforated gastric ulceration in a patient using meloxicam in conjunction with aspirin and diclofenac, and ileus in a patient using 45 mg meloxicam daily and prednisolone.[41] The most common gastrointestinal (GI) adverse events were dyspepsia (0.3%), nausea (0.2%), abdominal pain (0.1%), and diarrhea (0.1%); however, there was no dose effect seen between the 7.5 mg and 15 mg doses.[41]

In the Meloxicam Large-scale International Study Safety Assessment (MELISSA) trial, tolerability of meloxicam versus diclofenac was examined in the treatment of 9323 patients with osteoarthritis.[42] In a double-blind randomized controlled prospective trial, patients who met inclusion criteria received meloxicam (7.5 mg) or diclofenac (100 mg) for 28 days. Overall, patients who received meloxicam had less GI adverse events (13%) compared to diclofenac (19%), including dyspepsia, nausea, vomiting, abdominal pain, and diarrhea.[42] Furthermore, the GI events were not found to be as severe in patients who were given meloxicam compared to those given diclofenac.[42] Of the patients examined, three patients who received meloxicam spent a total of 5 days hospitalized due to GI events, and ten patients who received diclofenac spent a total of 121 days hospitalized for adverse GI events.[42]


There is concern that the prolonged use of NSAIDs can lead to adverse renal events, and researchers have posed questions regarding the safety of meloxicam use in those with compromised renal function. In patients with normal, mild, and moderate renal impairment who were administered meloxicam (15 mg) daily, free meloxicam concentrations were measured, and were found to be similar in all groups, thus suggesting it may not be necessary for a meloxicam dosage adjustment in patients with mild to moderate renal impairment.[43] Similarly, in a recent Phase 3 multi-center trial involving IV meloxicam use in patients with renal impairment for post-operative pain control, there was a low incidence of renal adverse events, and no significant difference in pharmacokinetics between patients with renal impairment and those without.[38]

A systemic review conducted by Asghar and Jamali,[44] evaluating 19 studies for renal and cardiovascular risk in meloxicam use, determined that meloxicam use did not result in an increase in the odds ratio of renal adverse events, as was seen with most NSAIDs (excluding ibuprofen). Zeidler et al.'s[41] research, noted above, described renal adverse reactions in four patients but did not detail the extent of reactions.


There have also been concerns about the risk of cardiovascular events with the use of NSAIDs and whether COX selectivity affects the occurrence of these adverse events. In the review by Asghar and Jamali,[44] five studies that reported >90 days of meloxicam usage and exposure did not show any increased risk of myocardial adverse events, but other NSAIDs such as rofecoxib and diclofenac were found to show increased risk. In regard to vascular events, meloxicam was found to have an elevated odds ratio compared to myocardial and renal events; however, of the NSAIDs evaluated, naproxen had the highest odds ratio of vascular events.[44] In terms of composite risk of cardiovascular and renal outcomes, meloxicam was found to have an elevated composite odds ratio, but this finding was not related to meloxicam dose.[44]

In the comprehensive study by Zeidler et al.,[41] no cases of myocardial infarction, hypertension, or cerebrovascular events were reported.


There is a paucity of studies that have directly examined hepatobiliary adverse events with the use of meloxicam specifically, rather with other NSAIDs. In the MELISSA trial noted earlier, serious adverse hepatobiliary events were seen in five patients in the diclofenac group, but no such events were observed in the meloxicam group.[42] Furthermore, statistically significant abnormal alanine aminotransferase (ALT) and aspartate aminotransferase (AST), as well as increases in creatinine and urea levels, were only seen in the diclofenac group.[42]

  Conclusions Top

Systemic administration of meloxicam is a safe and effective therapy to treat post-operative pain. Its relative selectivity for COX-2 may contribute to an improved tolerability profile. Meloxicam consistently reduces patients' opioid requirement by approximately 40%. These improvements, combined with the faster onset of analgesia and long duration of action, make meloxicam an attractive alternative to traditional NSAIDs during the perioperative period.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Wunsch H, Wijeysundera DN, Passarella MA, Neuman MD. Opioids prescribed after low-risk surgical procedures in the United States, 2004-2012. JAMA 2016;315:1654-7.  Back to cited text no. 1
American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: An updated report by the American Society of Anesthesiologists task force on acute pain management. Anesthesiology 2012;116:248-73.  Back to cited text no. 2
Engelhardt G. Pharmacology of meloxicam, a new non-steroidal anti-inflammatory drug with an improved safety profile through preferential inhibition of COX-2. Br J Rheumatol 1996;35 Suppl 1:4-12.  Back to cited text no. 3
Van Hecken A, Schwartz JI, Depré M, De Lepeleire I, Dallob A, Tanaka W, et al. Comparative inhibitory activity of rofecoxib, meloxicam, diclofenac, ibuprofen, and naproxen on COX-2 versus COX-1 in healthy volunteers. J Clin Pharmacol 2000;40:1109-20.  Back to cited text no. 4
Türck D, Roth W, Busch U. A review of the clinical pharmacokinetics of meloxicam. Br J Rheumatol 1996;35 Suppl 1:13-6.  Back to cited text no. 5
Ochi M, Kawachi T, Toita E, Hashimoto I, Yuminoki K, Onoue S, et al. Development of nanocrystal formulation of meloxicam with improved dissolution and pharmacokinetic behaviors. Int J Pharm 2014;474:151-6.  Back to cited text no. 6
Mack R, Freyeer A, Du W. An evaluation of the efficacy and safety of N1539, a novel intravenous formulation of nanocrystal meloxicam, in subjects with moderate to severe pain following hysterectomy (abstract 409). J Pain 2016;17:S77.  Back to cited text no. 7
Christensen SE, Cooper SA, Mack RJ, McCallum SW, Du W, Freyer A, et al. A randomized double-blind controlled trial of intravenous meloxicam in the treatment of pain following dental impaction surgery. J Clin Pharmacol 2018;58:593-605.  Back to cited text no. 8
Turck D, Busch U, Heinzel G, Narjes H. Clinical pharma-cokinetics of meloxicam. Eur J Rheumatol Inflamm 1995;15:22-34.  Back to cited text no. 9
Distel M, Bluhmki E. Global analysis of safety of meloxicam, a new enolic acid derived non-steroidal anti-inflammatory agent. Rheumatol Eur 1995;24 Suppl 3:39.  Back to cited text no. 10
Bannwarth B, Netter P, Pourel J, Royer RJ, Gaucher A. Clinical pharmacokinetics of nonsteroidal anti-inflammatory drugs in the cerebrospinal fluid. Biomed Pharmacother 1989;43:121-6.  Back to cited text no. 11
Busch U, Schmid J, Heinzel G, Schmaus H, Baierl J, Huber C, et al. Pharmacokinetics of meloxicam in animals and the relevance to humans. Drug Metab Dispos 1998;26:576-84.  Back to cited text no. 12
Guentert TW, Defoin R, Mosberg H. The influence of cholestyramine on the elimination of tenoxicam and piroxicam. Eur J Clin Pharmacol 1988;34:283-9.  Back to cited text no. 13
Degner F, Heinzel G, Busch U. Transsynovial kinetics of meloxicam. Scand J Rheumatol 1994;23 Suppl 98:121.  Back to cited text no. 14
Gottlieb IJ, Tunick DR, Mack RJ, McCallum SW, Howard CP, Freyer A, et al. Evaluation of the safety and efficacy of an intravenous nanocrystal formulation of meloxicam in the management of moderate-to-severe pain after bunionectomy. J Pain Res 2018;11:383-93.  Back to cited text no. 15
Reginster JY, Distel M, Bluhmki E. A double-blind, three-week study to compare the efficacy and safety of meloxicam 7.5 mg and meloxicam 15 mg in patients with rheumatoid arthritis. Br J Rheumatol 1996;35 Suppl 1:17-21.  Back to cited text no. 16
Pan JE, Xiong FL, Chen G, Zhang ZW, Xu YJ. Aquaporin-1 expression as an indicator in evaluating the efficacy of meloxicam in the treatment of ankylosing spondylitis: A comparative study. Biomed Pharmacother 2017;95:1549-55.  Back to cited text no. 17
Randall LO, Selitto JJ. A method for measurement of analgesic activity on inflamed tissue. Arch Int Pharmacodyn Ther 1957;111:409-19.  Back to cited text no. 18
Engelhardt G, Homma D, Schlegel K, Utzmann R, Schnitzler C. Anti-inflammatory, analgesic, antipyretic and related properties of meloxicam, a new non-steroidal anti-inflammatory agent with favourable gastrointestinal tolerance. Inflamm Res 1995;44:423-33.  Back to cited text no. 19
Furst DE, Kolba KS, Fleischmann R, Silverfield J, Greenwald M, Roth S, et al. Dose response and safety study of meloxicam up to 22.5 mg daily in rheumatoid arthritis: A 12 week multicenter, double blind, dose response study versus placebo and diclofenac. J Rheumatol 2002;29:436-46.  Back to cited text no. 20
Ahmed M, Khanna D, Furst DE. Meloxicam in rheumatoid arthritis. Expert Opin Drug Metab Toxicol 2005;1:739-51.  Back to cited text no. 21
Altman R, Hochberg M, Gibofsky A, Jaros M, Young C. Efficacy and safety of low-dose SoluMatrix meloxicam in the treatment of osteoarthritis pain: A 12-week, phase 3 study. Curr Med Res Opin 2015;31:2331-43.  Back to cited text no. 22
Hosie J, Distel M, Bluhmki E. Meloxicam in osteoarthritis: A 6-month, double-blind comparison with diclofenac sodium. Br J Rheumatol 1996;35 Suppl 1:39-43.  Back to cited text no. 23
Kurukahvecioglu O, Karamercan A, Ege B, Koksal H, Anadol Z, Tezel E, et al. Effect of meloxicam on postoperative pain relief after inguinal hernia repair with local anaesthesia. West Indian Med J 2007;56:530-3.  Back to cited text no. 24
Thompson JP, Sharpe P, Kiani S, Owen-Smith O. Effect of meloxicam on postoperative pain after abdominal hysterectomy. Br J Anaesth 2000;84:151-4.  Back to cited text no. 25
Aghadavoudi O, Saryazdi HH, Shafa A, Ramezani A. Comparison of pre-emptive effect of meloxicam and celecoxcib on post-operative analgesia: A double-blind, randomized clinical trial. Middle East J Anaesthesiol 2015;23:289-94.  Back to cited text no. 26
Moore RA, Derry S, McQuay HJ. Single dose oral meloxicam for acute postoperative pain in adults. Cochrane Database Syst Rev 2009;7:CD007552.  Back to cited text no. 27
Orozco-Solís M, García-Ávalos Y, Pichardo-Ramírez C, Tobías-Azúa F, Zapata-Morales JR, Aragon-Martínez OH, et al. Single dose of diclofenac or meloxicam for control of pain, facial swelling, and trismus in oral surgery. Med Oral Patol Oral Cir Bucal 2016;21:e127-34.  Back to cited text no. 28
Calvo AM, Sakai VT, Giglio FP, Modena KC, Colombini BL, Benetello V, et al. Analgesic and anti-inflammatory dose-response relationship of 7.5 and 15 mg meloxicam after lower third molar removal: A double-blind, randomized, crossover study. Int J Oral Maxillofac Surg 2007;36:26-31.  Back to cited text no. 29
Nekoofar MH, Sadeghipanah M, Dehpour AR. Evaluation of meloxicam (A cox-2 inhibitor) for management of postoperative endodontic pain: A double-blind placebo-controlled study. J Endod 2003;29:634-7.  Back to cited text no. 30
Zarif Najafi H, Oshagh M, Salehi P, Babanouri N, Torkan S. Comparison of the effects of preemptive acetaminophen, ibuprofen, and meloxicam on pain after separator placement: A randomized clinical trial. Prog Orthod 2015;16:34.  Back to cited text no. 31
Rajeswari SR, Gowda TM, Kumar TA, Thimmasetty J, Mehta DS. An appraisal of innovative meloxicam mucoadhesive films for periodontal postsurgical pain control: A double-blinded, randomized clinical trial of effectiveness. Contemp Clin Dent 2015;6:299-304.  Back to cited text no. 32
[PUBMED]  [Full text]  
Chen J, Gao Y. Strategies for meloxicam delivery to and across the skin: A review. Drug Deliv 2016;23:3146-56.  Back to cited text no. 33
Yuan Y, Chen XY, Li SM, Wei XY, Yao HM, Zhong DF, et al. Pharmacokinetic studies of meloxicam following oral and transdermal administration in beagle dogs. Acta Pharmacol Sin 2009;30:1060-4.  Back to cited text no. 34
Rømsing J, Mysager S, Vilmann P, Sonne J, Larsen NE, Stergaard D, et al. Postoperative analgesia is not different after local vs. systemic administration of meloxicam in patients undergoing inguinal hernia repair. Can J Anaesth 2001;48:978-84.  Back to cited text no. 35
Neil S, Matthew B, Sonia S, David L, Harold M, Stewart M, et al. Efficacy and safety of intravenous meloxicam in subjects with moderate-to-severe pain following abdominoplasty. Plast Reconstr Surg Glob Open 2018;6:e1846.  Back to cited text no. 36
Berkowitz R, Sharpe K, Mack R, McCallum, S, Gomez A, Freyer A, et al. Safety and Opioid Use Following Major Orthopedic Surgery in a Phase 3, Placebo-Controlled Study of Intravenous Meloxicam. Poster session presented at. Las Vegas, NV: PAINWeek Conference; 2017.  Back to cited text no. 37
Melson T, Boyer D, Mack R, McCallum S, Gomez A, Freyer A, et al. Safety and Opioid Use in Subjects of Advanced Age with Impaired Renal Function in a Phase 3, Placebo-Controlled Study of Intravenous Meloxicam Following Major Surgery. Poster session presented at. Las Vegas, NV: PAINWeek Conference; 2017.  Back to cited text no. 38
Takeda K, Sawamura S, Tamai H, Sekiyama H, Hanaoka K. Role for cyclooxygenase 2 in the development and maintenance of neuropathic pain and spinal glial activation. Anesthesiology 2005;103:837-44.  Back to cited text no. 39
Yamamoto D, Iwase S, Yoshida H, Kuroda Y, Yamamoto C, Kitamura K, et al. Efficacy of meloxicam in combination with preoperative chemotherapy for breast cancer – Japan Breast Cancer Research Network (JBCRN) 02-1 trial. Anticancer Res 2011;31:3567-71.  Back to cited text no. 40
Zeidler H, Kaltwasser JP, Leonard JP, Kohlmann T, Sigmund R, Degner F, et al. Prescription and tolerability of meloxicam in day-to-day practice: Postmarketing observational cohort study of 13,307 patients in Germany. J Clin Rheumatol 2002;8:305-15.  Back to cited text no. 41
Hawkey C, Kahan A, Steinbrück K, Alegre C, Baumelou E, Bégaud B, et al. Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients. International MELISSA study group. Meloxicam large-scale international study safety assessment. Br J Rheumatol 1998;37:937-45.  Back to cited text no. 42
Boulton-Jones JM, Geddes CG, Heinzel G, Türck D, Nehmiz G, Bevis PJ, et al. Meloxicam pharmacokinetics in renal impairment. Br J Clin Pharmacol 1997;43:35-40.  Back to cited text no. 43
Asghar W, Jamali F. The effect of COX-2-selective meloxicam on the myocardial, vascular and renal risks: A systematic review. Inflammopharmacology 2015;23:1-6.  Back to cited text no. 44


  [Table 1], [Table 2], [Table 3]

This article has been cited by
1 The Role of Exparel Plus Meloxicam for Postoperative Pain Management
Alan David Kaye,Matthew B. Novitch,Sam F. Carlson,Mitchell C. Fuller,Shane W. White,Alexander R. Haroldson,Jennifer A. Kaiser,Mohamed A. Elkersh,Andrew J. Brunk,George M. Jeha,Elyse M. Cornett
Current Pain and Headache Reports. 2020; 24(3)
[Pubmed] | [DOI]
2 Comparison of analgesic effect, knee joint function recovery, and safety profiles between pre-operative and post-operative administrations of meloxicam in knee osteoarthritis patients who underwent total knee arthroplasty
Yang Shao,Xiaoyan Zhao,Yu Zhai,Junfeng Yang,Shanfu Wang,Lei Liu,Jianwei Wang
Irish Journal of Medical Science (1971 -). 2020; 189(2): 535
[Pubmed] | [DOI]
3 Abcg2 transporter affects plasma, milk and tissue levels of meloxicam
Alba M. Garcia-Lino,Esther Blanco-Paniagua,Elsa N. Astorga-Simon,Laura Alvarez-Fernandez,Dafne Garcia-Mateos,Indira Alvarez-Fernandez,Ana I. Alvarez,Gracia Merino
Biochemical Pharmacology. 2020; 175: 113924
[Pubmed] | [DOI]
4 Control of pain in the early post-traumatic period in the outpatient practice. Results of the multi-center observational study RAPTOR (Rational Analgesia PostTraumatic: an Observational Research)
A. E. Karateev,A. M. Lila,N. V. Zagorodnii,V. N. Amirdzhanova,E. Lu. Pogozheva,E. S. Filatova,V. A. Nesterenko
Terapevticheskii arkhiv. 2020; 92(5): 69
[Pubmed] | [DOI]
5 Effect of castration procedure on the pharmacokinetics of meloxicam in goat kids
Ibrahim Ozan Tekeli,Erdinc Turk,Duygu Durna Corum,Orhan Corum,Kamil Uney
Journal of Veterinary Pharmacology and Therapeutics. 2020;
[Pubmed] | [DOI]
6 Evaluation of Experimental Multi-Particulate Polymer-Coated Drug Delivery Systems with Meloxicam
Mircea Hīrjau,Dalia Simona Miron,Valentina Anu?a,Dumitru Lupuliasa,Mihaela Violeta Ghica,Viorel Jinga,Cristina-Elena Dinu-Pīrvu
Coatings. 2020; 10(5): 490
[Pubmed] | [DOI]
7 Early preoperative versus postoperative administration of meloxicam in pain control, patient global status improvement, knee function recovery of arthroscopic knee surgery
Junde Hou,Wei Li,Yongxue Chen,Liping Yang,Liying Li,Lu Zhao
Medicine. 2019; 98(40): e17133
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Pharmacokinetic ...
   Pharmacodynamic ...
   Perioperative Us...
   Meloxicam for Tr...
   Article Tables

 Article Access Statistics
    PDF Downloaded547    
    Comments [Add]    
    Cited by others 7    

Recommend this journal