Adverse Effects of Meloxicam in Older Adults With Polypharmacy
Meloxicam exposure in older adults is associated with increased risks of serious gastrointestinal (GI) events, cardiovascular thrombotic events, and renal toxicity. [1] Older adults and those with multiple comorbidities have heightened susceptibility to these adverse effects during NSAID therapy. [1]
Serious Gastrointestinal Adverse Effects
Meloxicam is an NSAID and can cause serious GI adverse events including inflammation, bleeding, ulceration, and perforation. [1] Elderly patients have higher risk for serious GI events from NSAID therapy. [1] Upper GI ulcers, gross bleeding, or perforation occur in approximately 1% of patients treated for 3 to 6 months and in about 2% to 4% of patients treated for one year. [1] Only one in five patients who develop a serious upper GI adverse event on NSAID therapy is symptomatic, which increases the likelihood of delayed recognition. [1]
Renal Toxicity and Electrolyte Disturbances
Meloxicam can cause renal injury including renal papillary necrosis and other renal injury, particularly with long-term use. [1] Renal injury risk is increased in elderly patients and in patients with impaired renal function, heart failure, liver dysfunction, and those taking diuretics, ACE inhibitors, or angiotensin II receptor antagonists. [1] NSAIDs should be avoided when creatinine clearance is <30 mL/min in older adults because of increased risk of acute kidney injury and further decline of kidney function. [2]
Cardiovascular and Blood Pressure Effects
NSAIDs including meloxicam may increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke. [1] Risk may increase with duration of NSAID use. [1] New onset or worsening hypertension can occur during meloxicam therapy, and blood pressure monitoring is recommended. [1] Fluid retention and edema can occur, requiring caution in patients with fluid retention or heart failure. [1]
Drug-Interaction–Amplified Toxicity in Polypharmacy
Concomitant use of meloxicam with ACE inhibitors or angiotensin receptor antagonists in elderly patients, volume-depleted patients, or those with renal impairment can result in deterioration of renal function. [1] Concomitant use with diuretics increases concern for renal toxicity due to reduced renal perfusion in the setting of NSAID-associated hemodynamic effects. [1]
Beers Criteria Risk Stratification in Older Adults
NSAIDs are listed as medications that should be avoided in older adults with creatinine clearance <30 mL/min due to increased risk of acute kidney injury and further decline of kidney function. [2]
Common Adverse Events Occurring in Clinical Use
Reported common adverse reactions (incidence >2%) include abdominal pain, diarrhea, dyspepsia, flu syndrome, nausea, and dizziness. [1]
Adverse Effects Affecting Higher-Risk Organ Systems
Meloxicam can cause elevated liver enzymes and, rarely, severe hepatic reactions. [1] Meloxicam can cause serious skin adverse events including exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, and these can occur without warning. [1] Meloxicam can cause anaphylactoid reactions, which are severe hypersensitivity reactions. [1]
Practical Implications for Older Adults With Multiple Comorbidities
In older adults with polypharmacy, the most clinically consequential adverse effects to monitor during meloxicam therapy are GI bleeding/perforation, acute kidney injury, hypertension, edema/heart failure worsening, and cardiovascular thrombotic events. [1] Avoidance is recommended when creatinine clearance is <30 mL/min because NSAIDs increase risk of acute kidney injury and further kidney function decline. [2]