Mobic | Pharmacology Mentor

Generic Name

Mobic

COX inhibition: *Mobic* preferentially inhibits cyclo‑oxygenase‑2 (COX‑2) over COX‑1, reducing the synthesis of prostaglandin E2 and other inflammatory mediators.
Reduced gastric irritation: COX‑1 suppression is minimal, lowering the risk of gastrointestinal mucosal damage compared with non‑selective NSAIDs.
Analgesic and anti‑inflammatory effects: The decreased prostaglandin production diminishes peripheral sensitization, inflammation, and edema, resulting in pain relief and decreased joint swelling.

Absorption: Oral bioavailability is ~70 %; peak plasma concentrations occur 1–3 h post‑dose.
Distribution: Highly protein‑bound (~96 % to albumin). Lipophilic, distributes widely into tissues.
Metabolism: Hepatic via CYP2C9 and CYP3A4; metabolites are inactive.
Elimination: 75–80 % excreted renally (urine), remainder in feces.
Half‑life: 15–20 h (steady‑state ~20 h); supports once‑daily dosing.
Food effect: No clinically meaningful impact.

Osteoarthritis (OA) and rheumatoid arthritis (RA) pain management.
Post‑operative analgesia for minor to moderate pain.
Musculoskeletal inflammatory conditions refractory to acetaminophen and other NSAIDs when COX‑2 selective therapy is preferred.

Hypersensitivity to meloxicam, any NSAID, or sulfonamide derivatives.
Severe cardiovascular disease (recent myocardial infarction, unstable angina, uncontrolled angina, decompensated heart failure).
Severe hepatic impairment.
Severe renal insufficiency (creatinine clearance 3× ULN; consider liver function monitoring in patients with preexisting liver disease.

Population	Starting Dose	Titration	Maintenance	Max Daily Dose
Adults (OA/RA)	7.5 mg orally once daily	May increase to 15 mg/day if pain control inadequate	7.5–15 mg/day	15 mg
Elderly (>65 yr)	2.5–7.5 mg daily	Start low, monitor for renal or GI events	2.5–15 mg	15 mg
Patients with mild–moderate hepatic impairment	7.5 mg daily	Monitor hepatic enzymes	7.5 mg	15 mg
Never exceed 15 mg/day; do not use >3 days in pregnancy.

• Take with food or milk to reduce gastric irritation.
• Do not abruptly discontinue; taper gradually if clinically warranted.

Baseline & periodic: CBC, CMP (liver enzymes, renal function), BP.
Renal function: CrCl or eGFR every 3–6 months in patients >65 yr or with comorbid conditions.
Cardiovascular: Monitor for edema, hypertension; assess risk at baseline.
GI: Evaluate for signs of bleeding (melena, hematochezia).
Patient education: Report any abdominal pain, black stools, or signs of allergic reaction promptly.

COX‑2 Selectivity Matters: *Mobic* has a higher COX‑2:COX‑1 selectivity ratio (~20:1), making it safer for the gastrointestinal tract but *not* free of GI risk; always co‑prescribe with a proton‑pump inhibitor (PPI) in patients with high GI risk.
Pregnancy Safety Profile: Avoid *Mobic* after 28 weeks of gestation; if used during the first two trimesters, monitor for fetal renal function and consider switching to paracetamol.
Dosing in Renal Insufficiency: In patients with creatinine clearance 30–50 mL/min, start at 5 mg daily; avoid in CKD stage 4–5.
Drug Interactions: CYP2C9 inhibitors (e.g., fluconazole, erythromycin) can raise meloxicam plasma levels; reduce dose or monitor closely. Anticoagulants (warfarin, rivaroxaban) should be used cautiously due to additive bleeding risk.
Cardiovascular Precautions: The 2005 meta‑analysis of NSAIDs showed increased cardiovascular events; *Mobic* still presents moderate risk – restrict use in patients with established CV disease or multiple risk factors.
Rebound Pain: Abrupt discontinuation can worsen pain; if stopping therapy, taper slowly or use an alternative analgesic strategy.

*(All recommendations comply with current FDA labeling and recent clinical pharmacology literature up to 2026.)*