meloxicam

Meloxicam is indicated for the treatment of osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis.

{{See also|Nonsteroidal anti-inflammatory drug}}

Meloxicam use can result in gastrointestinal toxicity and bleeding, headaches, rash, and very dark or black stool (a sign of intestinal bleeding). It has fewer gastrointestinal side effects than diclofenac, piroxicam,{{cite journal | vauthors = Dequeker J, Hawkey C, Kahan A, Steinbrück K, Alegre C, Baumelou E, Bégaud B, Isomäki H, Littlejohn G, Mau J, Papazoglou S | title = Improvement in gastrointestinal tolerability of the selective cyclooxygenase (COX)-2 inhibitor, meloxicam, compared with piroxicam: results of the Safety and Efficacy Large-scale Evaluation of COX-inhibiting Therapies (SELECT) trial in osteoarthritis | journal = British Journal of Rheumatology | volume = 37 | issue = 9 | pages = 946–51 | date = September 1998 | pmid = 9783758 | doi = 10.1093/rheumatology/37.9.946 | doi-access = free | title-link = doi }} naproxen,{{cite journal | vauthors = Wojtulewski JA, Schattenkirchner M, Barceló P, Le Loët X, Bevis PJ, Bluhmki E, Distel M | title = A six-month double-blind trial to compare the efficacy and safety of meloxicam 7.5 mg daily and naproxen 750 mg daily in patients with rheumatoid arthritis | journal = British Journal of Rheumatology | volume = 35 | issue = Suppl 1 | pages = 22–8 | date = April 1996 | pmid = 8630632 | doi = 10.1093/rheumatology/35.suppl_1.22 | doi-access = free | title-link = doi }} and perhaps all other NSAIDs which are not COX-2 selective.{{cite journal | vauthors = Hawkey C, Kahan A, Steinbrück K, Alegre C, Baumelou E, Bégaud B, Dequeker J, Isomäki H, Littlejohn G, Mau J, Papazoglou S | title = Gastrointestinal tolerability of meloxicam compared to diclofenac in osteoarthritis patients. International MELISSA Study Group. Meloxicam Large-scale International Study Safety Assessment | journal = British Journal of Rheumatology | volume = 37 | issue = 9 | pages = 937–45 | date = September 1998 | pmid = 9783757 | doi = 10.1093/rheumatology/37.9.937 | doi-access = free | title-link = doi }}

In October 2020, the US Food and Drug Administration (FDA) required the prescription drug label to be updated for all nonsteroidal anti-inflammatory medications to describe the risk of kidney problems in unborn babies that result in low amniotic fluid. They recommend avoiding NSAIDs in pregnant women at 20 weeks or later in pregnancy.{{cite press release | title=FDA Warns that Using a Type of Pain and Fever Medication in Second Half of Pregnancy Could Lead to Complications | website=U.S. Food and Drug Administration (FDA) | date=15 October 2020 | url=https://www.fda.gov/news-events/press-announcements/fda-warns-using-type-pain-and-fever-medication-second-half-pregnancy-could-lead-complications | access-date=15 October 2020}} {{PD-notice}}{{cite web | title=NSAIDs may cause rare kidney problems in unborn babies | website=U.S. Food and Drug Administration (FDA) | date=21 July 2017 | url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-avoiding-use-nsaids-pregnancy-20-weeks-or-later-because-they-can-result-low-amniotic | access-date=15 October 2020}} {{PD-notice}}

Like other NSAIDs, its use is associated with an increased risk of cardiovascular events such as heart attack and stroke.{{cite journal | vauthors = Stamm O, Latscha U, Janecek P, Campana A | title = Development of a special electrode for continuous subcutaneous pH measurement in the infant scalp | journal = American Journal of Obstetrics and Gynecology | volume = 124 | issue = 2 | pages = 193–195 | date = January 1976 | pmid = 2012 | doi = 10.1016/S0002-9378(16)33297-5 }} Although meloxicam inhibits formation of thromboxane A, it does not appear to do so at levels that would interfere with platelet function.{{cite journal | vauthors = Zeidan AZ, Al Sayed B, Bargaoui N, Djebbar M, Djennane M, Donald R, El Deeb K, Joudeh RA, Nabhan A, Schug SA | title = A review of the efficacy, safety, and cost-effectiveness of COX-2 inhibitors for Africa and the Middle East region | journal = Pain Practice | volume = 13 | issue = 4 | pages = 316–331 | date = April 2013 | pmid = 22931375 | doi = 10.1111/j.1533-2500.2012.00591.x | s2cid = 205715393 }} A pooled analysis of randomized, controlled studies of meloxicam therapy of up to 60 days duration found that meloxicam was associated with a statistically significantly lower number of thromboembolic complications than the NSAID diclofenac (0.2% versus 0.8% respectively) but a similar incidence of thromboembolic events to naproxen and piroxicam.{{cite journal | vauthors = Singh G, Lanes S, Triadafilopoulos G | title = Risk of serious upper gastrointestinal and cardiovascular thromboembolic complications with meloxicam | journal = The American Journal of Medicine | volume = 117 | issue = 2 | pages = 100–106 | date = July 2004 | pmid = 15234645 | doi = 10.1016/j.amjmed.2004.03.012 }}

People with hypertension, high cholesterol, or diabetes are at risk for cardiovascular side effects. People with family history of heart disease, heart attack, or stroke should tell their treating physician as the potential for serious cardiovascular side effects is significant.{{cite web|url=https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601242.html|title=Meloxicam|publisher=MedlinePlus|access-date=15 November 2014|archive-date=29 November 2014|archive-url=https://web.archive.org/web/20141129020509/http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601242.html|url-status=live}}{{cite web|url=https://www.drugs.com/meloxicam.html|title=Meloxicam|publisher=Drugs.com|access-date=15 November 2014|archive-date=16 November 2014|archive-url=https://web.archive.org/web/20141116214049/http://www.drugs.com/meloxicam.html|url-status=live}}

NSAIDs cause an increase in the risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients are at greater risk for serious gastrointestinal events.

{{Main|Non-steroidal anti-inflammatory drug}}

Meloxicam blocks cyclooxygenase (COX), the enzyme responsible for converting arachidonic acid into prostaglandin H₂—the first step in the synthesis of prostaglandins, which are mediators of inflammation.

Meloxicam has been shown, especially at low therapeutic doses, to selectively inhibit COX-2 over COX-1.{{cite journal | vauthors = Noble S, Balfour JA | title = Meloxicam | journal = Drugs | volume = 51 | issue = 3 | pages = 424–30; discussion 431–32 | date = March 1996 | pmid = 8882380 | doi = 10.2165/00003495-199651030-00007 | s2cid = 260452199 }}

Meloxicam concentrations in synovial fluid range from 40% to 50% of those in plasma. The free fraction in synovial fluid is 2.5 times higher than in plasma, due to the lower albumin content in synovial fluid compared to plasma. The significance of this penetration is unknown,{{cite web|url= https://www.drugs.com/pro/meloxicam.html|publisher= Drugs.com|access-date= 17 March 2010|title= Meloxicam official FDA information, side effects, and uses|date= March 2010|archive-date= 16 March 2010|archive-url= https://web.archive.org/web/20100316170923/http://www.drugs.com/pro/meloxicam.html|url-status= live}} but it may account for the fact that it performs exceptionally well in treatment of arthritis in animal models.{{cite journal | vauthors = Engelhardt G, Homma D, Schlegel K, Utzmann R, Schnitzler C | s2cid = 37937305 | title = Anti-inflammatory, analgesic, antipyretic and related properties of meloxicam, a new non-steroidal anti-inflammatory agent with favourable gastrointestinal tolerance | journal = Inflammation Research | volume = 44 | issue = 10 | pages = 423–33 | date = October 1995 | pmid = 8564518 | doi = 10.1007/BF01757699 }}

The bioavailability of meloxicam is decreased when administered orally compared to an equivalent IV bolus dose. Different oral formulations of meloxicam are not bioequivalent. Use of oral meloxicam following a high-fat breakfast increases the mean peak drug levels by about 22%; however, the manufacturer does not make any specific meal recommendations. In addition, the use of antacids does not show pharmacokinetic interactions. With chronic dosing, the time to maximum plasma concentration following oral administration is approximately 5–6 hours.

The mean volume of distribution of meloxicam is approximately 10 L. It is highly protein-bound, mainly to albumin.{{cite journal | vauthors = Gates BJ, Nguyen TT, Setter SM, Davies NM | title = Meloxicam: a reappraisal of pharmacokinetics, efficacy and safety | journal = Expert Opinion on Pharmacotherapy | volume = 6 | issue = 12 | pages = 2117–2140 | date = October 2005 | pmid = 16197363 | doi = 10.1517/14656566.6.12.2117 | quote = Meloxicam is extensively bound to plasma proteins (99.4%), primarily to albumin. Meloxicam has an apparent volume of distribution (Vd) 10 – 15 L in humans (0.1 – 0.2 L/kg) after oral administration and a mean volume of distribution at steady-state of 0.2 L/kg after intravenous administration."
"None of the meloxicam treatment groups demonstrated inhibition of platelet aggregation to either arachidonic acid (AC) or adenosine diphosphate (ADP). However, there were no significant changes in the platelet count, prothrombin, and activated partial thromboplastin time in any of the meloxicam and indomethacin groups. Other crossover studies also confirmed that meloxicam 15 mg/day caused a major reduction of maximum thromboxane production, but no reduction in collagen- or AC-induced platelet aggregation. | s2cid = 25512189 }}{{cite journal | vauthors = Bekker A, Kloepping C, Collingwood S | title = Meloxicam in the management of post-operative pain: Narrative review | journal = Journal of Anaesthesiology Clinical Pharmacology | volume = 34 | issue = 4 | pages = 450–457 | date = 2018 | pmid = 30774225 | pmc = 6360894 | doi = 10.4103/joacp.JOACP_133_18 | doi-access = free | title-link = doi }}

Meloxicam is extensively metabolized in the liver by the enzymes CYP2C9 and CYP3A4 (minor) into four inactive metabolites. Peroxidase activity is thought to be responsible for the other two remaining metabolites.{{Cite web|url=https://www.drugs.com/ppa/meloxicam.html|title=Meloxicam (Professional Patient Advice)|publisher=Drugs.com|access-date=6 August 2019|archive-date=6 August 2019|archive-url=https://web.archive.org/web/20190806165006/https://www.drugs.com/ppa/meloxicam.html|url-status=live}}

Meloxicam is predominantly excreted in the form of metabolites and occurs to equal extents in the urine and feces. Traces of unchanged parent drug are found in urine and feces. The mean elimination half-life ranges from 15 to 20 hours.

Adverse events are dose-dependent and associated with length of treatment.{{cite journal | vauthors = ((2019 American Geriatrics Society Beers Criteria Update Expert Panel)) | s2cid = 59338182 | title = American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults | journal = Journal of the American Geriatrics Society | volume = 67 | issue = 4 | pages = 674–694 | date = April 2019 | pmid = 30693946 | doi = 10.1111/jgs.15767 }}

Meloxicam is used in veterinary medicine mainly to treat dogs,{{cite web | title=Metacam- meloxicam suspension | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ed2227e6-8c69-4057-a8b2-94f74cb11264 | access-date=15 May 2021}}{{cite web | title=Metacam- meloxicam injection, solution | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ca78caf5-2b47-46c1-abec-0f925b39f455 | access-date=15 May 2021}} but also sees off-label use in other animals such as cattle and exotics.Off-label use discussed in: Arnold Plotnick MS, DVM, ACVIM, ABVP, [http://www.manhattancats.com/Articles/pain.html Pain Management using Metacam] {{webarchive|url=https://web.archive.org/web/20110714025604/http://www.manhattancats.com/Articles/pain.html |date=14 July 2011 }}, and Stein, Robert, [http://www.vasg.org/perioperative_pain_management_part_iv.htm Perioperative Pain Management] {{Webarchive|url=https://web.archive.org/web/20100418035553/http://www.vasg.org/perioperative_pain_management_part_iv.htm |date=18 April 2010 }} Part IV, Looking Beyond Butorphanol, Sep 2006, Veterinary Anesthesia & Analgesia Support Group.For off-label use example in rabbits, see Krempels, Dana, [http://www.bio.miami.edu/hare/paresis.html Hind Limb Paresis and Paralysis in Rabbits] {{Webarchive|url=https://web.archive.org/web/20100617192652/http://www.bio.miami.edu/hare/paresis.html |date=17 June 2010 }}, University of Miami Biology Department. In the European Union and other countries it is not considered off-label and can be used in cattle, pigs, horses, dogs, cats and guinea pigs.{{Cite web |date=2006-07-31 |title=Metacam |url=https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam |access-date=2024-11-17 |website=European Medicines Agency (EMA) }} It has also been investigated as an alternative to diclofenac by the Royal Society for the Protection of Birds (RSPB) to prevent deaths of vultures.{{cite journal |vauthors=Swan G, Naidoo V, Cuthbert R, Green RE, Pain DJ, Swarup D, Prakash V, Taggart M, Bekker L, Das D, Diekmann J, Diekmann M, Killian E, Meharg A, Patra RC, Saini M, Wolter K |date=March 2006 |title=Removing the threat of diclofenac to critically endangered Asian vultures |journal=PLOS Biology |volume=4 |issue=3 |pages=e66 |doi=10.1371/journal.pbio.0040066 |pmc=1351921 |pmid=16435886 | doi-access = free | title-link = doi }}

Depending on the animal species, each country or union of countries applies different guidelines or legal frameworks for the use of the drug, as well as different recorded side effects. The most common side effects in dogs include gastrointestinal irritation (vomiting, diarrhea, and ulceration). As far as the perioperative administration is concerned, in healthy dogs given meloxicam, no perioperative adverse effects on the cardiovascular system have been reported at recommended dosages.{{cite journal | vauthors = Boström IM, Nyman G, Hoppe A, Lord P | title = Effects of meloxicam on renal function in dogs with hypotension during anaesthesia | journal = Veterinary Anaesthesia and Analgesia | volume = 33 | issue = 1 | pages = 62–9 | date = January 2006 | pmid = 16412133 | doi = 10.1111/j.1467-2995.2005.00208.x }} Perioperative administration of meloxicam to cats did not affect postoperative respiratory rate nor heart rate.{{cite journal | vauthors = Höglund OV, Dyall B, Gräsman V, Edner A, Olsson U, Höglund K | s2cid = 30649716 | title = Effect of non-steroidal anti-inflammatory drugs on postoperative respiratory and heart rate in cats subjected to ovariohysterectomy | journal = Journal of Feline Medicine and Surgery | volume = 20 | issue = 10 | pages = 980–984 | date = October 2018 | pmid = 29165006 | doi = 10.1177/1098612X17742290 | pmc = 11129237 }}

The issue of using meloxicam in cats involves conflicting guidelines, differing legislation, and a narrow therapeutic safety margin that can easily turn the drug from cure to poison. More specifically:

The US Food and Drug Administration (FDA) approves the use of meloxicam in cats only in injectable form and only as a one-time injection given before surgery.{{Cite web |date=29 September 2022 |title=Get the Facts about Pain Relievers for Pets |url=https://www.fda.gov/animal-veterinary/animal-health-literacy/get-facts-about-pain-relievers-pets |website=U.S. Food and Drug Administration (FDA) }}{{Cite web |date=15 August 2023 |title=What Veterinarians Should Advise Clients About Pain Control and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Dogs and Cats |url=https://www.fda.gov/animal-veterinary/resources-you/what-veterinarians-should-advise-clients-about-pain-control-and-nonsteroidal-anti-inflammatory-drugs |website=U.S. Food and Drug Administration (FDA) }} It does not approve meloxicam oral suspension for cats and it does not approve meloxicam spray for cats because after reviewing numerous reports of meloxicam side effects in cats, it has identified many cases of acute renal failure and death and has added the following boxed warning to the prescription label: "Repeated use of meloxicam in cats has been associated with acute renal failure and death. Do not administer additional injectable or oral meloxicam to cats. See Contraindications, Warnings, and Precautions for detailed information."{{Cite web |date=14 August 2023 |title=Information about the Boxed Warning on Meloxicam Labels regarding Safety Risks in Cats |url=https://www.fda.gov/animal-veterinary/product-safety-information/information-about-boxed-warning-meloxicam-labels-regarding-safety-risks-cats |website=U.S. Food and Drug Administration (FDA) }}

In contrast, in the European Union and other continents or countries, the use of the drug in cats is allowed with no such warning.{{Cite web |title=Metacam |url=https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam |access-date=29 March 2024 |website=European Medicines Agency (EMA)|date=31 July 2006 }}{{Cite news |title=Cats: Meloxicam Question for Department for Environment, Food and Rural Affairs |url=https://questions-statements.parliament.uk/written-questions/detail/2021-05-11/HL10/ |work=UK Parliament Written questions, answers and statements}} The product instruction leaflet for meloxicam for cats in the form of oral suspension 0.5 mg/ml states that: "Typical adverse reactions of NSAIDs such as loss of appetite, vomiting, diarrhoea, faecal occult blood, apathy, and renal failure have occasionally been reported. These side effects are in most cases transient and disappear following termination of the treatment but in very rare cases may be serious or fatal."{{Cite web |title=Clinical particulars - Meloxidyl 0.5 mg/ml oral suspension for cats |url=https://www.noahcompendium.co.uk/?id=-474521 |access-date=29 March 2024 |website=www.noahcompendium.co.uk }}

The data sheets for meloxicam products for cats also state that: "Meloxicam has a narrow therapeutic safety margin in cats and clinical signs of overdose may be seen at relatively small overdose levels."

Some additional information about giving meloxicam to cats from researchers is as follows: A peer-reviewed journal article cites NSAIDs, including meloxicam, as causing gastrointestinal upset and, at high doses, acute kidney injury and CNS signs such as seizures and comas in cats. It adds that cats have a low tolerance for NSAIDs.{{cite journal |date=1 June 2006 |title=Toxicology Brief: The 10 most common toxicoses in cats |url=http://veterinarymedicine.dvm360.com/toxicology-brief-10-most-common-toxicoses-cats?id=&sk=&date=&pageID=3 |url-status=live |journal=Dvm360 |archive-url=https://web.archive.org/web/20180829212043/http://veterinarymedicine.dvm360.com/toxicology-brief-10-most-common-toxicoses-cats?id=&sk=&date=&pageID=3 |archive-date=29 August 2018 |access-date=16 September 2018}}{{cite journal |vauthors=Merola V, Dunayer E |date=June 2006 |title=The 10 most common toxicoses in cats |url=https://www.aspcapro.org/sites/default/files/zl-vetm0606_339-342.pdf |url-status=live |journal=Veterinary Medicine |pages=340–342 |archive-url=https://web.archive.org/web/20190809040133/https://www.aspcapro.org/sites/default/files/zl-vetm0606_339-342.pdf |archive-date=9 August 2019 |access-date=9 August 2019}} Also, in another scientific journal there is talk of research according to which cats that received meloxicam had greater proteinuria at 6 months than cats that received placebo. It was concluded that meloxicam should be used with caution in cats with chronic kidney disease.{{cite journal |vauthors=KuKanich K, George C, Roush JK, Sharp S, Farace G, Yerramilli M, Peterson S, Grauer GF |date=February 2021 |title=Effects of low-dose meloxicam in cats with chronic kidney disease |journal=Journal of Feline Medicine and Surgery |volume=23 |issue=2 |pages=138–148 |doi=10.1177/1098612X20935750 |pmid=32594827 |s2cid=220256059|pmc=10741344 }}

In dogs, the absorption of meloxicam from the stomach is not affected by the presence of food,{{cite journal | vauthors = Khan SA, McLean MK | title = Toxicology of frequently encountered nonsteroidal anti-inflammatory drugs in dogs and cats | journal = The Veterinary Clinics of North America. Small Animal Practice | volume = 42 | issue = 2 | pages = 289–306, vi-vii | date = March 2012 | pmid = 22381180 | doi = 10.1016/j.cvsm.2012.01.003 }} with the peak concentration (C_max) of meloxicam occurring in the blood 7–8 hours after administration. The half-life of meloxicam is approximately 24 hours in dogs. In the koala (Phascolarctos cinereus), very little meloxicam is absorbed into the blood after oral administration (that is, it has poor bioavailability).{{cite journal | vauthors = Kimble B, Black LA, Li KM, Valtchev P, Gilchrist S, Gillett A, Higgins DP, Krockenberger MB, Govendir M | title = Pharmacokinetics of meloxicam in koalas (Phascolarctos cinereus) after intravenous, subcutaneous and oral administration | journal = Journal of Veterinary Pharmacology and Therapeutics | volume = 36 | issue = 5 | pages = 486–93 | date = October 2013 | pmid = 23406022 | doi = 10.1111/jvp.12038 | doi-access = free | title-link = doi }}

2003: Meloxicam was approved in the US for use in dogs for the management of pain and inflammation associated with osteoarthritis, as an oral (liquid) formulation of meloxicam.{{cite web |url=https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118006.pdf|title=NADA 141-213: New Animal Drug Application Approval (for Metacam (meloxicam) 0.5 mg/mL and 1.5 mg/mL Oral Suspension)|date=15 April 2003|publisher=U.S. Food and Drug Administration (FDA)|access-date=24 July 2010|archive-url=https://wayback.archive-it.org/7993/20170406084237/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118006.pdf|archive-date=6 April 2017|url-status=dead}}

2003 (November): An injectable formulation for use in dogs was approved by the US Food and Drug Administration (FDA).{{cite web |date=12 November 2003 |title=NADA 141-219: Metacam (meloxicam) 5 mg/mL Solution for Injection |url=https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118026.pdf |url-status=dead |archive-url=https://wayback.archive-it.org/7993/20171115072315/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118026.pdf |archive-date=15 November 2017 |access-date=8 August 2019 |publisher=U.S. Food and Drug Administration (FDA) |df=dmy-all}}

2004 (October): A formulation for use in cats was approved for use before surgery only.{{cite web |date=28 October 2004 |title=Metacam 5 mg/mL Solution for Injection, Supplemental Approval |url=https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118027.pdf |url-status=dead |archive-url=https://wayback.archive-it.org/7993/20171115072316/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/FOIADrugSummaries/ucm118027.pdf |archive-date=15 November 2017 |access-date=8 August 2019 |publisher=U.S. Food and Drug Administration (FDA) |df=dmy-all}} This is an injectable meloxicam, indicated for as a single, one-time dose only, with specific and repeated warnings not to administer a second dose.See the manufacturer's [http://www.metacam.com/index.php/FAQs-Veterinary-Professionals FAQ] {{Webarchive|url=https://web.archive.org/web/20110702180646/http://www.metacam.com/index.php/FAQs-Veterinary-Professionals|date=2 July 2011}} on its website, and its [http://www.bi-vetmedica.com/product_sites/METACAMINCats/documents/Metacam_Inj_cats_label.pdf clinical dosing instructions for cats.] {{webarchive|url=https://web.archive.org/web/20080906211039/http://www.bi-vetmedica.com/product_sites/METACAMINCats/documents/Metacam_Inj_cats_label.pdf|date=6 September 2008}}

2005 (January): The product insert added a warning in bold-face type: "Do not use in cats."{{cite web | url=https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/UCM050394.pdf | title=Client Information Sheet For Metacam (meloxicam) 1.5 mg/mL Oral Suspension | publisher=U.S. Food and Drug Administration (FDA) | quote=Metacam is a prescription non-steroidal anti-inflammatory drug (NSAID) that is used to control pain and inflammation (soreness) due to osteoarthritis in dogs. Osteoarthritis (OA) is a painful condition caused by “wear and tear” of cartilage and other parts of the joints that may result in the following changes or signs in your dog: Limping or lameness, decreased activity or exercise (reluctance to stand, climb stairs, jump or run, or difficulty in performing these activities), stiffness or decreased movement of joints. Metacam is given to dogs by mouth. Do not use Metacam Oral Suspension in cats. Acute kidney injury and death have been associated with the use of meloxicam in cats. | date=January 2005 | archive-url=https://wayback.archive-it.org/7993/20171115070141/https://www.fda.gov/downloads/AnimalVeterinary/Products/ApprovedAnimalDrugProducts/DrugLabels/UCM050394.pdf | archive-date=15 November 2017 | url-status=dead | df=dmy-all}}

2005: The FDA sent a Notice of Violation to the manufacturer for its promotional materials which included promotion of the drug for off-label use.{{cite web | url=https://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/ComplianceEnforcement/ucm042460.pdf | title=Notice of Violation | date=19 April 2005 | publisher=U.S. Food and Drug Administration (FDA) |access-date=8 August 2019 | archive-url=https://wayback.archive-it.org/7993/20170113141217/https://www.fda.gov/downloads/AnimalVeterinary/GuidanceComplianceEnforcement/ComplianceEnforcement/ucm042460.pdf | archive-date=13 January 2017 | url-status=dead | df=dmy-all }}

2020 (February): A meloxicam injection was approved for use in the United States. Specifically, the FDA granted the approval of Anjeso to Baudax Bio.{{cite press release | title=Baudax Bio Announces FDA Approval of Anjeso for the Management of Moderate to Severe Pain | website=Baudax Bio, Inc. | date=20 February 2020 | url=https://www.baudaxbio.com/news-and-investors/press-releases/detail/160/baudax-bio-announces-fda-approval-of-anjeso-for-the | access-date=20 February 2020 | archive-date=21 February 2020 | archive-url=https://web.archive.org/web/20200221055028/https://www.baudaxbio.com/news-and-investors/press-releases/detail/160/baudax-bio-announces-fda-approval-of-anjeso-for-the | url-status=live }}{{cite web | title=Anjeso (meloxicam) injection, for intravenous use | url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210583s000lbl.pdf | publisher=U.S. Food and Drug Administration (FDA) | date=February 2020 | access-date=21 February 2020 | archive-date=22 February 2020 | archive-url=https://web.archive.org/web/20200222070146/https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/210583s000lbl.pdf | url-status=live }}

In the European Union, meloxicam is licensed for other anti-inflammatory benefits including relief from both acute and chronic pain in dogs. Meloxicam is also licensed for use in horses, to relieve the pain associated with musculoskeletal disorders.{{cite book| veditors = Maddison JE, Page SW, Church D |title=Small animal clinical pharmacology | url = https://archive.org/details/smallanimalclini00mrcv | url-access = limited |date=2008 |publisher= Saunders/Elsevier |location=Edinburgh |isbn=9780702028588 |pages=[https://archive.org/details/smallanimalclini00mrcv/page/n305 301]–302 |edition=2nd |chapter=Meloxicam }}

1998 (January): Meloxicam was authorised for use in cattle throughout the European Union, via a centralised marketing authorisation.{{cite journal | vauthors = Wright E |title=Generic and biosimilar medicinal products in the European Union |journal=Chemistry Today |date=March 2007 |volume=25 |issue=2 |pages=4–6 |url=https://www.hoganlovells.com/~/media/hogan-lovells/pdf/publication/chemistrytodayapr07_pdf.pdf |access-date=28 January 2020 |archive-date=28 January 2020 |archive-url=https://web.archive.org/web/20200128032019/https://www.hoganlovells.com/~/media/hogan-lovells/pdf/publication/chemistrytodayapr07_pdf.pdf |url-status=live }}

2006: The first generic meloxicam product was approved.

2024 (January): EMA issued an 'Opinion'{{Cite web |date=2024-01-19 |title=Meeting highlights from the Committee for Veterinary Medicinal Products (CVMP) 16-17 January 2024 {{!}} European Medicines Agency (EMA) |url=https://www.ema.europa.eu/en/news/meeting-highlights-committee-veterinary-medicinal-products-cvmp-16-17-january-2024 |access-date=2025-01-25 |website=www.ema.europa.eu |language=en}} on a change to this medicine's authorisation concerning the follow-up oral treatment after initial injectable administration in cats. This change remains as an 'Opinion', while the medication continues to be approved as usual.{{Cite web |date=2006-07-31 |title=Metacam |url=https://www.ema.europa.eu/en/medicines/veterinary/EPAR/metacam |access-date=2024-11-16 |website=European Medicines Agency (EMA) }}

{{As of|June 2008}}, meloxicam is registered for long-term use in cats in Australia, New Zealand, and Canada.{{cite book | veditors = Gaschen FP, Schaer M |title=Clinical medicine of the dog and cat |date=2016 |publisher=CRC Press |isbn=9781482226065 |page= |edition=3rd |chapter-url=https://books.google.com/books?id=fjqLDQAAQBAJ&dq=meloxicam+cat+australia&pg=PT2004 |chapter=Recent NSAID developments |access-date=28 January 2020 |archive-date=1 September 2020 |archive-url=https://web.archive.org/web/20200901204800/https://www.google.com/books/edition/Clinical_Medicine_of_the_Dog_and_Cat/fjqLDQAAQBAJ?hl=en&gbpv=1&dq=meloxicam+cat+australia&pg=PT2004 |url-status=live }}

In the United Kingdom, meloxicam is licensed for use in cats, guinea pigs, horses, and livestock including pigs and cattle. {{cite web |title=Product Information Database |url=https://www.vmd.defra.gov.uk/ProductInformationDatabase/current?page=79&order=ActiveSubstances&descending=True |website=Veterinary Medicines Directorate |publisher=DEFRA |access-date=29 March 2023}}

• Bupivacaine/meloxicam

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