Meloxicam

An oxicam nonsteroidal anti-inflammatory drug with analgesic, anti-inflammatory and antipyretic activity. It is used for musculoskeletal and perioperative pain, with species- and formulation-specific regimens.

Group

Oxicam nonsteroidal anti-inflammatory drug (NSAID)

Mechanism of Action

Inhibits cyclooxygenase-mediated prostaglandin synthesis, reducing inflammation, pain and fever. It is relatively COX-2 preferential, but this does not eliminate gastrointestinal or renal toxicity.

Prostaglandin suppression can impair renal perfusion in dehydrated, hypovolemic or hypotensive patients. Meloxicam is highly protein bound; disposition and tolerance differ substantially between species.

Dose Rates

Dog

• Musculoskeletal pain: 0.2 mg/kg PO (loading), once; adult; no reproductive safety concerns; Initial administration only
• Musculoskeletal pain: 0.2 mg/kg SC (loading), once; adult; no reproductive safety concerns; Initial administration only
• Musculoskeletal pain: 0.2 mg/kg IV (loading), once; adult; no reproductive safety concerns; Initial administration only
• Musculoskeletal pain: 0.1 mg/kg PO (maintenance), q24h; adult; no reproductive safety concerns; Begin after the initial dose
• Musculoskeletal pain: 0.1 mg/kg SC (maintenance), q24h; adult; no reproductive safety concerns; Begin after the initial dose
• Musculoskeletal pain: 0.1 mg/kg IV (maintenance), q24h; adult; no reproductive safety concerns; Begin after the initial dose
• Musculoskeletal pain: oral spray: 0.1 mg/kg OTM, q24h; Product-specific oral spray

Cat

• Chronic musculoskeletal pain: GB feline oral protocol: 0.1 mg/kg PO (loading), once; at least 6 weeks; no renal disease
• Chronic musculoskeletal pain: GB feline oral protocol: 0.05 mg/kg PO (maintenance), q24h; at least 6 weeks; no renal disease; Use only the matching feline oral protocol
• Chronic pain: reduced-dose option (24-hour interval): 0.03 mg/kg PO, q24h; Individualized long-term regimen
• Chronic pain: reduced-dose option (48-hour interval): 0.05 mg/kg PO, q48h; Individualized long-term regimen
• Chronic pain: reduced-dose option (73-hour interval): 0.05 mg/kg PO, q73h; Individualized long-term regimen
• Chronic pain with renal disease: 0.01–0.03 mg/kg PO, q24h; older cat with chronic kidney disease
• Postoperative pain: source injection range: 0.15–0.3 mg/kg SC, once; Do not repeat injection
• Postoperative pain: US single-injection protocol: 0.3 mg/kg SC, once; at least 4 months; normal renal function; Preoperative only; no additional meloxicam or NSAID

Pig

• Pain and inflammation: 0.4 mg/kg IM, once; A second administration may be given after 24 hours

Cattle

• Pain and inflammation: repeated-injection regimen: 0.5 mg/kg IV, q24h
• Pain and inflammation: repeated-injection regimen: 0.5 mg/kg IM, q24h
• Pain and inflammation: repeated-injection regimen: 0.5 mg/kg SC, q24h
• Adjunctive analgesia: single-injection protocol: 0.5 mg/kg IV, once; for diarrhea: calf older than 1 week or young nonlactating cattle; With treatment appropriate to the underlying condition
• Adjunctive analgesia: single-injection protocol: 0.5 mg/kg SC, once; for diarrhea: calf older than 1 week or young nonlactating cattle; With treatment appropriate to the underlying condition

Sheep and Goats

• Pain and inflammation: 1 mg/kg IV, once
• Pain and inflammation: 1 mg/kg IM, once
• Pain and inflammation: 1 mg/kg SC, once
• Pain and inflammation: 1 mg/kg PO, once

Horse

• Musculoskeletal pain: 0.6 mg/kg IV, q24h; at least 6 weeks; not pregnant or lactating
• Musculoskeletal pain: 0.6 mg/kg PO, q24h; up to 14 days; at least 6 weeks; not pregnant or lactating
• Pain and inflammation: single-injection protocol: 0.6 mg/kg IV, once; at least 6 weeks; not pregnant or lactating; Oral continuation is a separate regimen
• Foal pain: increased-frequency regimen: 0.6 mg/kg IV, q12h; foal younger than 7 weeks
• Foal pain: increased-frequency regimen: 0.6 mg/kg PO, q12h; foal younger than 7 weeks

Indications

• Osteoarthritis and other musculoskeletal pain in dogs
• Acute or chronic musculoskeletal pain and selected postoperative pain protocols in cats
• Musculoskeletal pain and inflammation in horses
• Adjunctive analgesia in bovine respiratory disease, diarrhea, acute mastitis and dehorning
• Noninfectious locomotor inflammation and adjunctive treatment of mastitis-metritis-agalactia syndrome in pigs
• Extralabel pain relief in sheep and other small ruminants

Contraindications

• Hypersensitivity to meloxicam, formulation excipients or other NSAIDs
• Active gastrointestinal ulceration or hemorrhage; hemorrhagic disorders
• Dehydration, hypovolemia or hypotension; impaired renal, hepatic or cardiac function
• Concurrent treatment with another NSAID or a corticosteroid
• Pregnancy and lactation in cats and mares; canine reproductive safety is unestablished
• For the selected GB products, cats and horses younger than 6 weeks; bovine diarrhea treatment in calves younger than 1 week
• Repeated feline dosing after the US single-injection regimen is contraindicated; do not combine that regimen with an oral follow-up course
• Safety of the selected US products is unestablished in dogs younger than 6 months and of the injectable product in cats younger than 4 months

Interactions

• Other NSAIDs and glucocorticoids increase gastrointestinal injury and bleeding risk
• Diuretics, ACE inhibitors and other drugs affecting renal perfusion may increase renal risk or reduce treatment response
• Potentially nephrotoxic medicines, including aminoglycosides, increase renal injury risk
• Anticoagulants increase bleeding risk; competition with highly protein-bound medicines may alter drug exposure

Adverse effects

• Vomiting, diarrhea, reduced appetite and lethargy
• Gastrointestinal ulceration, hemorrhage or perforation
• Azotemia and acute kidney injury
• Elevated hepatic enzymes or hepatic injury
• Injection-site discomfort or swelling
• Rare hypersensitivity or anaphylactoid reactions

Toxicity

Overdose or administration to susceptible patients can cause severe gastrointestinal injury and renal failure; cats have a narrow safety margin. Stop meloxicam and provide supportive treatment directed at hydration, renal perfusion, gastrointestinal injury and electrolyte disturbances. No specific antidote is established. Repeated dosing in cats has been associated with renal failure and death.

Preparations

• Metacam 1.5 mg/mL oral suspension for dogs — oral liquid: meloxicam 1.5 mg/mL (US)
• Metacam 0.5 mg/mL oral suspension for dogs — oral liquid: meloxicam 0.5 mg/mL (US)
• Metacam 5 mg/mL solution for injection — injection: meloxicam 5 mg/mL (US)
• Metacam 0.5 mg/mL oral suspension for cats and guinea pigs — oral liquid: meloxicam 0.5 mg/mL (GB)
• Metacam 20 mg/mL solution for injection for cattle, pigs and horses — injection: meloxicam 20 mg/mL (GB)
• Metacam 15 mg/mL oral suspension for horses — oral liquid: meloxicam 15 mg/mL (GB)
• Inj. Melonex (5mg/mL) — injection: meloxicam 5 mg/mL